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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 /> Ann Maeder <br /> ie._,_. 1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) c4 Zoning Status; CUP; <br /> 4583 Conestoga Trail Deed Restriction; CSM <br /> HOME PHONE CELL PHONE Variance(# ) = Va4 <br /> E-MAIL ADDRESS <br /> (608)839-5483 (608)206-7575 annmaeder4 @gmail.com o Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension <br /> AGENT NAME CONTRACTOR NAME <br /> 4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Q Setbacks 7 D /OA <br /> PHONE PHONE Site Plan approval from //' <br /> applicable township. /li <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> %Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r a <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: KElevatlon of property f <br /> 0 NUM ER 0711-031-5386-1 R-1 DCPREZ-0000-02168 0.66 frontage drawn to scale. <br /> TOWNSHIP: SECTIONo / <br /> Cottage Grove D J �4. le E ihy44. (/1. ►� riveway permi <br /> ADDRESS: ,,/ (state,county, l � <br /> 4583 Conestoga Trail We 3,1- 4if .Ail h oi-a <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public • is <br /> 46 American Heritage (public . <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Above Ground Pool 2_ 2 /J t Zoning District <br /> 2_08 <br /> 4 This project is a new building or structure. <br /> X.Permitted Use? /4 i, v 6 r <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ORuralA s M <br /> EWER JEPTIC ,832 (new/ istin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 5.0 2.0 ,Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> ` or: 17:1. attachment) /- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ^� s ErosionControl permit �- <br /> �2 ` ,, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, ! l <br /> 2ND FLOOR: 3RD FLOOR: filling/access) ,/� <br /> 572.0 ,i <br /> eview Location Survey Al/ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. j� <br /> (Please round to nearest dollar) $ 3,000.00 /�' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓Nlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ✓I Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ZNo <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) Dies ❑No 4Don't know <br /> 7. Is this to correct a violation? 11 es EN° <br /> ^ A • ION MUST BE SIGNED <br /> 7 Q <br /> 545-112(4/08) L (Continue ue ,n Back) —► <br /> M <br />