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ZONING SUPPLEMENT to Web-App# <br /> 0 ING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Patrick & Mari Buchholz <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction; CSM <br /> 5216 Black Walnut Dr. McFalrland, WI 53558 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)575-0380 <br /> Q Site Plan drawn to Cale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Brad North Hart DeNoble Builders, Inc <br /> Site Plan ' uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se is <br /> 7923 Airport Road 7923 Airport Road <br /> (City,State,Zip) (City,State,Zip) 0 Setb C S <br /> Middelton, WI 53562 Middelton, WI 53562 <br /> PHONE PHONE ['Site Plan pr om <br /> (608) 831-4422 (608) 831-4422 applica o ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bnorth @denoblebuilders.com jfranzen @denoblebuilders.com 0 Floor plank t6 scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Q Elevation Vf p perty <br /> PARENT PARCEL NUMBER: CURRENT Z• ING12 ACR i=i <br /> ['PARCEL 071111385908 !/v//• • r frontage dr n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: �..L ` � <br /> Town of Cottage Grove 11 �/4. nw 1/4�/4: sw I0.k eta <br /> 4 ADDRESS: (state,count ) <br /> IsS <br /> 2045 Co HWY BB <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION' <br /> New single family residence ❑ Zonin istrict <br /> . ISIThis project is a new building or structure. ❑ PermittiUse? <br /> ['This project is an addition/alteration to an existing building or structure. �` / <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad esS 0/10-44C, • <br /> 13,201 ,600,329 (new/ isti ) t�i ` <br /> EWER �/ EPTIC `� <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) <br /> l CI Wetland/ to•���' / <br /> II -- 7{REATO NEAREST SQUARE FOOT: Shorela • • hment) <br /> (Outside dimensions inkk(id'ng unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT ' 1ST FLOOR: ' `// ❑ ErosionCo r• !-rmit <br /> 4 788.0 7 356.0 4 TOTAL SQUARE FOOTAGE: + (slopes, • -,.0•' :, • <br /> 3RD FLOOR: filling/acres• <br /> 2ND FLOOR: <br /> 1 ,225.0 4 13,369.0 <br /> CI Review c S ey <br /> ESTIMATED CONSTRUCTION COST: and avai ons. <br /> (Please round to nearest dollar) "i -* - ♦ .- $ 1 ,100,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [✓Yes 151No EDon'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 ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LJYes ISINo <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 ISINo ['Don't know <br /> 7. Is this to correct a violation? Elves is No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 taros, (Continue on Back) -► <br />