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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> OWN 8�55�r,r�-, I 'R./r�,�1 AAG�L �r7dning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City State,Zip) Deed Restriction;CSM
<br /> 311 Ot �r�2.K- 'R� r C- -2-�‘E�c Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> S- Z34- 84cr� S Zeal n drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION -and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ,.Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> nHRIS MILLED CONST. LLC
<br /> �,`(city,state gyp) 3186 KINNEY RD. (city,state,zip).RRIS Iv1ILLER CONST. LI.0 © Setbacks
<br /> COTTAGE GROVE,WI 5352; 3186 KINNEY RD.
<br /> PHONE PHONE COTTA!-E GROVE.,�,`i 5352' Q Site Plan approval from
<br /> ^ 26(© ^-I !o--6 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> R]Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ,�' ACREAGE: ❑ Elevati • property
<br /> ❑ PARCEL p 1 fronta raven to scale.
<br /> NUMBER OZ4` 0-7('Z-Zo 3-� DSO... 1 1��"t ' ' Z.Zip (,C.
<br /> TOWNSHIP:
<br /> SECTION: ❑
<br /> .;.J I�'Z,-p. /s:. %IA: Dri rmitS
<br /> ADDRESS: (Stat.6 unty,town)
<br /> 3'l taf� Ic �R2, �� V �, -E gyp' ❑ Sani ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> i 3 � (pub•' rivate)
<br /> PROPOSED PROJECT INFORMATION - ,S
<br /> PROJECT DESCRIPTION: 4�
<br /> 2 DC- LS (e6.914:3, uis-r'wcY ' k3�
<br /> 7 IR This project is a new building or structure. , {
<br /> ®This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: �i � !
<br /> nsEWER nSEPTIC (7.• )i5 !:,:;;IF' '
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> Iii,..., _,;,,,1,,,,, ,,,,,,,,:,:.:,,‘,-
<br /> rn r.¢
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) °
<br /> BASEMENT: 1ST FLOOR: j TOTAL SQUARE FOOTAGE: + E °
<br /> b 1 (a�s�� #2 6-i� � - 04
<br /> 2ND FLOOR: 3RD FL 1
<br /> �racc.vVES STA1R5) 2y I 2 -
<br /> ll
<br /> ESTIMATED CONSTRUCTION COST �`��' �� ( :J•/ '
<br /> (Please round to nearest dollar) "� '� "�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ❑No ®Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Oyes No Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes El No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) El yes No
<br /> El Don't know
<br /> 7. Is this to correct a violation? ❑Yes i!No
<br /> APPUCATION T
<br /> (Continue on BacMUS BE k) -+SIGNED♦ -♦
<br /> 545-112(4/08)
<br />
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