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ZONING PERMIT APPLICATION 1www.countyofdane.com F3223:133121232211 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Kirk Everson <br /> — — ___ - ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number Street.City State.Zip( Deed Restriction:CSM <br /> N8545 Ridge Rd Van Dyne WI 54979 Variance(# ) <br /> — --- — <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (920)979-1259 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ,CONT-ACTOR NAME <br /> Matter Construction Services LLC ❑Site Plan including location <br /> AGENT ADDRESS ,CO 1 TRACTOR ADDRESS of well/septic <br /> 8 Cty Rd S <br /> (City,State.Zip) ,(City State.Zip) ❑Setbacks <br /> Kewaskum WI 53040 <br /> PHONE PHONE __ — _ 0 Site Plan approval from <br /> (920) 979-3123 applicable township. <br /> E-MAIL ADDRESS — -- — , ----t-------- <br /> E-MAILADDRESS <br /> j ericmatter12 @gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wI.usn ❑ <br /> El PARCEL PARENT PARCEL NUMBER CURR:NT ZONING Elevation of property <br /> 1 ACREAGE Elevation <br /> drawn to scale. <br /> NUMBER <br /> TOWNSHIP <br /> +SECTIbN <br /> Cottage Grove 1 4 V. �/4�/4: ❑Driveway permits <br /> I -4---- (state.county.town <br /> ADDRESS -- --- ( Y+ ) <br /> 4721 Gaston Circle <br /> ---- [Sanitary permits <br /> CSM. LOT `SUBDIVISION 7BLOCK/LOT (public, nV <br /> 6,734 1 (p p ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> Rebuild burned down home on existing foundation J Zoning District <br /> . ❑This project is a new building or structure. <br /> Permitted Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICEWER EPTIC (PERMI NUMBER J Rural Address <br /> �' (new/existing) <br /> — <br /> HEIGHT IN FEET 1 NUMBER OF STORIES (Not;ndudmg basement) <br /> 15.0 I 1.0 J Wetland/Floodplain/ <br /> -- — Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area.attached .arages and above grade decks or porches) <br /> BASEMENT. p 1ST FLOOR u ErosionControl permit <br /> 1,008 ! 1,300.0 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> ------ — filling/access) <br /> 2ND FLOOR 1 3RD FLOOR 1,1 OO.O <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -. ♦ -i ♦ 140,000.00 and available options. <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? ❑Yes Otslo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [ Yes o ✓❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑✓Yes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes 'lo <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) ❑Yes 'lo ['Don't know <br /> 7. Is this to correct a violation? Dyes EjNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ —► <br /> 545-112 14/081 <br />