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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 /> SI-Cu E 4 3'EU NI -C' GR-- GC.-1 S ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1p(..p I 6 CN Ev-v AR- - SUN)-PP-A\v„..\4 t,.l 1 S 35 8 ci Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ‘10g-3 7/n - (9 4'7 j-oe,re,c,ar,s'"D CLv4t+QC r\4:27‘-' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CHRIS bllLLCi �,ONST. LLC CONTRACTOR ADDRESS of well/septic <br /> 3136 KiNNEY RD. <br /> (City,State,Zip) COTTACE GROVE, WI 535271 <br /> (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> i9CrS -2i3(Q -i 1 a(o applicable township. <br /> E-MAIL ADDRESS 7 E-MAIL ADDRESS <br /> C{,r;5 •rr,,: 110 r ca- S— .r , . " — r-,(2_. . , ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi-us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 1 frontage drawn to scale. <br /> NUMBER ciS(07/ I-2"-3i{`87S8 'd R1-{-- t Z- .O fyG g <br /> TOWNSHIP: lI SECTION: <br /> 65-CIA G E �-cr-,_iE 1/4. 1/41/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> /C1 3 Li +A vsilee. 1----""se0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Li 59 3 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> -SF R_ ❑ Zoning District <br /> . EjThis project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> EWER PEPTIC (3 -2,0 I.? — 00 38 L1 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 2 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> ZO 9 i 3,CO Sc - o O 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> R(78 6 I-� I�.� <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ –i• and available options. <br /> (Please round to nearest dollar) $ 45E) S Off, <br /> , 5_S Z- L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ❑No ®Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑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 NNo <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) Lives laio ❑Don't know <br /> 7. Is this to correct a violation? Lives rao <br /> Rs MSS 2.o9t- h..41,0 zaci`t <br /> q S Pk,,-Rc� IS-1 APPLICATION MUST BE SIGNED <br /> 545-112(4/08)�G t�oS PC�k Z�8 3 © (Continue on Back) - -♦ <br /> coy.P zn-k, 114 1 <br /> CN2. I cr2o <br />