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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 /> a=61.4 fQ ez442..1, S ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 23 2 E-1 c rt'N c Cs3T1t4 6 E Gie av€1 Li r S `3 5 2,i Variance(# ) <br /> HOME PHONE CELE PHONE E-MAIL ADDRESS <br /> 68 a-219 -z39 e Z ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CHRIS MIL' ER CONST_Lt C ❑ Site Plan including location <br /> AGENT ADDRESS 3186 KINNEY RD. CONTRACTOR ADDRESS of well/septic <br /> CnTTA IF RRCVF WI s152 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> (acsg-2-6(4. -1 (a(c applicable township. <br /> E-MAIL ADDRE SS E-MAIL ADDRESS r <br /> �h ri5 •I"+'„ ;I k- r�s-ir u c r� D- <br /> s_ Cam ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 0t(01es6Iz-21 I -&&3t)-O RN - 1 2.9 Ac_ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> •�'-- 1/4� 1/1/4. ❑ Driveway permits <br /> CN�.yr +ate _ — (state,county,town) <br /> ADDRESS: _ <br /> co LA"`_ r'`,� ❑ Sanitary permits <br /> CSM: LOT SUBDI ION BLOCK/LOT <br /> 3 '7 (a 3 3 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> I <br /> PROJECT DESCRIPTION: l 11 eV.) �1e ev%E U a <br /> ,'tbiCt <br /> . Et This project is a new building or structure. W°Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ® Rural Address <br /> (SEWER RtEPTIC 13`''z I - -a ao 4 (ne ! vz, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ice. S . - ., at�I�t)- <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> �"Er(s(c�t s x� s <br /> BASEMENT: 1ST FLOOR: " <br /> IG 411 39 11 1 +. TOTAL SQUARE FOOTAGE: I 17g` +€ g •-n cef <br /> 2ND FLOOR: I 3RD FLOOR: <br /> 5'3.' 4 (43 „ � <br /> ESTIMATED CONSTRUCTION COST: 0 R� ��Survey <br /> `, l <br /> (Please round to nearest dollar) ♦ ♦ -0 -0 ♦ ♦ $ 3 co F� !' R CS '� <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? ❑Yes 2 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? Dyes ElNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# /0(o 32>) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes NiNo <br /> -- ec....,..-r I89i9 <br /> - P�P�a �� - rnA,� 1$9 APPLICATION MUST BE SIGNED <br /> 545-112(4i08) —5 c� z25 (Continue on Back) -+ ♦ -► <br /> - C.alz. toil' ._o�K. 33� }39 `I <br /> - p• t 238 <br />