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rct (moi /-01-1--f 6 SI -1--- <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Korey Kahl <br /> -- .......... Vning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 10016 US Highway 14, Black Earth, WI 53515 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)767-2228 (608)212-2100 kkbuilders99@yahoo.com ip Site Plan drawn sc <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dime ions <br /> AGENT NAME > p yCQNTRACTOR,N4ME - `f <br /> e.--bill I*e4'1 14e-r-E�4& t L 13j Site Plan i clu ' location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sept <br /> /00/4) V5 WY "/ <br /> (City,State,Zip) (City ` te,Zip) ' ❑SetbN s <br /> G1,i-eLL _+i-rt, t<A7 63Sis <br /> PHONE PHONE 0 Site Pla � val from <br /> rD iS- Z~ o c applicadle 4 hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> K,g!jovt'ick y5 qq,e., v4-huv,C-o►'i ❑ Floor pl'o scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wl.usI) ❑ Elevation f perty <br /> PARENT ,PARCEL NUMBER: ICURRENTZONING: ACRE, <br /> ❑PARCEL 0806-233-9501-7 t 0�3 frontage wn to scale. <br /> NUMBER <br /> TOWNSHIP: I SECTION: <br /> .t4t<L E,Nr. ❑ Driveway permits <br /> ADDRESS: <br /> (state, nty,town) <br /> (00/ ( 0S ti 4111 ) tt ❑Sani rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu r ee) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Net) to&SQ-. ❑ Zoning ect <br /> Eirhis project is a new building or structure. ❑ Permitte? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D Rural Ad• <br /> ne7/1.e... EWER rEPTIC (new/e r sting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ./ "7-'0%;/_.. ❑ Wetla i o ain/ <br /> Shorel.ne ( achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: E(OSIOnCOn '�7 <br /> 9.2 a• y TOTAL SQUARE FOOTAGE: , (S •r:4 r��f] 1 <br /> QS 9 - —. filli •/ac ss <br /> 2ND FLOOR: 3RD FLOOR: <br /> aa0'W ❑ Review Lo••, • Survey. <br /> ESTIMATED CONSTRUCTION COST: --1. --I. / [JOOO <br /> and availa' 4. Ions. <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? QYes ..No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Ill es 2,No [ Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2, es ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes gNo <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)_ OYes fallo ❑Don't know <br /> 7. Is this to correct a violation? Eyes .���„ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -4 <br /> 545-112141081 <br />