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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyotdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE �/ <br /> OWNER NAME g !1 1 <br /> c7p,mss.}. lC e>t-t.,y -A to-0 az- C-- a Zoning Status;CUP; (t <br /> OWNER ADDRESS (Number,Street.City,State,Zip) •eed Restriction;CSM <br /> 41 g -Pat?--IL-.. J c-il.n5 R1") , V. - i E---ID , 1,-.3 l 535.E I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4.:5S--Zr 2, tt,l 3 Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ig Site Plan including location <br /> AGENT ADDRESS CHRIS MILLER CONST. LLC CONTRACTOR ADDRESS of well/septic <br /> 3186 KINNEY RD. Cl!R 3D 7/o/o MILL�i CCN,ST. Setbacks V <br /> (city,State,zip) GU I t P'aE UHJVE,WI 5352 (City.state,Zip)Co r� 3 t 86'K1NNEY i3p, LLC <br /> PHONE <br /> PHONE `n, .0 0'tE..:. WI 5;52. 41 Site Plan approval from 4. <br /> applicable township. <br /> E-MAIL ADDRESS ` E-MAIL ADDRESS r Floor plans to scale <br /> 0...11,-.1.s-m; `145.r C ern r1/4.)4..A t 2rY\ lam 1 , caVe''1 / i <br /> PROPERTY/LOCATION INFORMATION (http://accossdafe.co.dane.wi.us/) �r Elevation of property 1 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: frontage drawn to scat <br /> 0 PARCEL °'3 l2 —3� W l`TT1TT 2 ACS <br /> NUMBER �"'� ��� " <br /> TOWNSHIP: SECTION: DriveWa er ` <br /> D�C( \ �, 3'2— A. 5 '�'/": S t'') (state,coun town <br /> ADDRESS: <br /> 1 12-3 ~ ft' t( R: 'D E t t E--O ) r2KSanita ,�• - �- <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,is i' "` <br /> 1 � t5C 1 <br /> PROPOSED PROJECT INFORMATION SrTAFF REVIEW' <br /> PROJECT DESCRIPTION: • <br /> C>� 7� t0� ��J L� J Tl� fCv � J �✓� @pii 'jt''„{a�17 WhS� t�����3�� <br /> . This project is a new building or structVVturre. "eft ed U e r <br /> 0 This project is an addition/alteration to an existing building or structure. ' A ' r <br /> PERMIT NUMBER: .2 , ' ')t <br /> SANITARY SERVICE: 1: a 3 - r p <br /> �t��wrl.�� ' <br /> []SEWER []SEPTIC _ e „Sty r <br /> HEIGHT IN FEET: / ` t, NUMBER OF STORIES: (Not including basement) 9 x <br /> AREA TO NEAREST SQUARE FOOT: _ t a ;-zz t , w <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) * sl : <br /> BASEMENT: 1ST FLOOR: t' / <br /> 4 TOTAL SQUARE FOOTAGE: 4 . <br /> 3 2� <br /> 2ND FLOOR: 3RD FLOOR: a' // r <br /> 21 it s, d0 vxL �'f� ' s; <br /> ESTIMATED CONSTRUCTION COST: 4441 !,(� t* ; <br /> (Please round to nearest dollar) / li <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYeslo 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? D Yes } No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ' Yes u No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Yes Q.No ❑Don't know <br /> 7. Is this to correct a violation? - No <br /> 4- APPLICAT IAN MUST BE SIGNED <br /> (Cont. . - on Back) —► —► —1 <br /> 545-112(4108) <br />