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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 /> RE 10 ± -2-OTO G- N - D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 33O-7 Nee S 'RD , ,Sur.) faek t c<A . Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 " 4=68-22S -t(ocj J 201JGH S' P-1a. I, --, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> s M:Iler Construction LLC M LI-eV-la-403SS ❑ Site Plan including location <br /> AGE ITADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3186 Kinney Rd. La 01."2.- e R EE <br /> (City,State,ZipOfottagc Grove,Wi 53527 (City,State,Zip) n Setbacks <br /> _ _ n i-1'�a2 )i-t IA) 1 5 35 s Lt <br /> PHONE 'PHONE + ❑Site Plan approval from <br /> ec,og T 206-I/0G (002" - © <br /> ' L — 385 3applicable township. <br /> AI <br /> E-MAIL ADDRESS E-MLADDRESS <br /> ehri.s.rri(itr.crelgIr'uc 'ta,-,� Y"'' -. -Cicry-v-N Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.cadiane.wi.usl) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL a l4 /ts,S/d -2.113-ao i 2 0RR.-2 7 r 2 act E frontage drawn to scale. <br /> NUMBER r <br /> TOWNSHIP: SECTION: <br /> ? iJ 1/4. 1/41/4: n Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 3307 &7 RV• S vi -F(2-.1q k RAC ❑ Sanitary permits <br /> CSM: LOT 2 `SUBDIVISION BLOCK/LOT (public,private) <br /> LJ ti4uS w <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Swei? 32'X36'SHED W/4'X8'PORCH, FOR RES. STORGE AND GARDEN TOOLS ❑ Zoning District <br /> . NIThis project is a new building or structure. LI Permitted Use?YES <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address EX <br /> EWEREPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ NO <br /> i- Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Li ErosionControl permit <br /> BASEMENT: 1STFLOOR: 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, NO <br /> II1 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 11 e <br /> l_. ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: - - ♦ ♦ .- ♦ $ . ,5 ,3 and available options. NO <br /> (Please round to nearest dollar) 1 <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. 13 there d wetland or floodplain on or near the property? ❑Yes EjNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑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) nYes INNo nDon't know <br /> 7. Is this to correct a violation? EYes No <br /> $168.40 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -4 -+ <br /> 545-112(4108) <br />