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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 /> Gary F. Stueber <br /> 0 Zoning Status;CUP; <br /> owNeRADDRESS (Ntritber,Stns,City,state,zip) Deed Restriction;CSM <br /> 2651 Gston Road Cottage Grove,Wisconsin 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)839-5387 (608)575-4556 s2bcar1vet@aol.com D Site Plan drawn to scale <br /> AGENT INFORMATION ;CONTRACTOR INFORMATION and indudes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _ Site Plan including location <br /> AGENT AnoResS CONTRACTOR ofwell/SEptiC <br /> (CitY.State,MP) (City,ate, 0 Setbacks <br /> PHONE PHONE 0 Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ElFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accossdane.co.dane.wi.us/)a0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE <br /> a�M 018/0711-051-9520-5 RH1 2.65 frontage drawn to scale_ <br /> TOWNSHIP: SECTION: <br /> Cottage Grove 5 I SE +N/: NE ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 2651 Gaston Road Cottage Grove Wisconsin <br /> -- Sanitary <br /> _CSM: LOT SUBDIVISION BLOCK/LOT 2,980 1 ubliC private) <br /> PROPOSED PROJECT INFORMATION 61 <br /> PROJECT DESCRIPTION ."-∎:::' _.y 7•;':',"S'.'./.;1•'•,'.."'� rt':'7;',;:in:=%;"_:;1 <br /> 13 x 20 storage shed q:?Z `Di :,,, ; =F <br /> .vnui�: <br /> • l_.1This project is a new budding or structure. , <br /> QThls project is an addition/alteration to an existing building or structure. °, : ' �;" ?" z'-"' <br /> SANITARY SERVICE :4�. Rutal Addre s i:,: ...- <br /> PERMIT '`: 't.:." <br /> R (�EPTIO :1 7....,",,u hng.=;, . <br /> HEIGHT IN ht_ / NUMBER OF STORIES: (Not Including basement) ., ' • ' ,'''':4;': '''' "''::7:7::::.:: <br /> AREA TO NEAREST SQUARE FOOT !S � '.1g- ^ '•"'�: � <br /> :- ,-+ <br /> (Outside dimensions including unfinished area.attached garages and above grade decks or porches) U :;'�•''``ii. ` t, I'S . ;, <br /> : :';iosion7Cptif dl'*P rttl "', ,; <br /> BASEMENT, 1ST FLOOR L ..r +<.r...;z•',;�r:;��';;i:<+'i <br /> j TOTAL SQUARE FOOTAGE: +, (mopes;•dtshr.r 9.: A 4 ' <br /> :ail ,;7.;::.,,,, };,-{ <br /> 2ND FLOOR. 3RD FLOOR: / <br /> ESTIMATED CONSTRUCTION COST ''0 eV1�V !lt,odati0rt?Su' .; ::• <br /> JR � �yr:..;.y, <br /> (Please round to nearest dollar) -► -► -a - -1. -- $ 1,500.00 a[ld'aVa t o"O tf ri , ''`. <br /> 1_ The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ES • ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes IN o IDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes • • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? „,. ES • <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#2 O s .) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Q • D3on't know <br /> 7. Is this to correct a violation? Dyes [lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112( ) (Continue on Back) -0. -I. -► <br />