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ZONING PERMIT APPLICATION www.countyotdane.com ' ' i <br /> 1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Rodney Homburg <br /> OWNER ADDRESS (Number,Street.City.State,Zip) oning Status; CUP; <br /> ..\"/ <br /> Deed Restriction;CSM <br /> 4137 Vilas Hope Road, Cottage Grove,WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE ----1E-MAIL ADDRESS <br /> (608)222-7213 (608)772-3011 bhomburg @att.net ' e Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Owner [J,2ff "an including location <br /> AGENT ADDRESS y CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) ,(City.State,Zip) , <br /> PHONE PHONE 0❑Site a oval from <br /> i ��appli e t nship. <br /> E-MAIL ADDRESS !E-MAIL ADDRESS <br /> r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/(accessdane,co.dane.wi.us/) Ele tion of <br /> PARENT PARCEL NUMBER: i CURRENT ZONING: ACREAGE: property <br /> ©PARCEL i 018/0711-1824530-5 1 RH-1 ..%ili 3.65 ntage drawn to scale. <br /> OWNSHIP: SECTION: <br /> Cottage Grove i 18 1/4: SE ls : NW ❑Driv ay its <br /> ADDRESS 4137 Vilas Hope Road, Cottage Grove, W1 53527 (State Inty,town) <br /> CSM: I LOT -1-SUBDIVISION BLOCKA OT -- ❑Sant•: • its <br /> 6,146 2 i (pub •, •i vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION /�/ <br /> Detached Garage x I1' onin District <br /> This project is a new building or structure. <br /> p a g P rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 1 PERMrf N MB R: Rural Ad`s <br /> iiiiii <br /> .EWER REPTIC (ne t • <br /> HEIGHT IN FEET: NUMBER OF TORIES: (Not including basement) <br /> _ W-1i. •lFlo••:lain/ <br /> - _ Shorelan..,. .chment) <br /> AR ' TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: I 1ST FLOOR: Ef0$IOn O permit <br /> 0.0 I 576.0 t TOTAL SQUARE FOOTAGE: ,, (slopes, turbance, <br /> filling/ <br /> 2ND FLOOR:0.0 I3RD FLOOR:0.0 1 576.0 <br /> 0.0 t 576.0 Review on Survey <br /> ESTIMATED CONSTRUCTION COST: and av , b o tions. <br /> (Please round to nearest dollar) -► -* -i -. -* -♦ $ 5,300.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [3Yes [}lo [on t know <br /> 2. Is there a wetland or floodplain on or near the property? Yes Elo )on't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes OW <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? laes ✓ON° <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 ✓No [ on't know <br /> 7. Is this to correct a violation? Dies ✓4lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4 <br /> 545-112(4/08) <br />