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SUPPLEMENT to Web-App # <br /> ZONNG PERMT APPUCAIION WiMACCountycidane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Jeremy & Krista Potter <br /> E2 Zoning Status;CUP; <br /> 1 4 eattt erNtt,, .ottage urove, Wi 53527 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CE 6�0P O4N 9-7379 E-MAIL ADDRESS <br /> > <br /> 12 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME TRACTOR NA <br /> elnzman g1_ome Repair & Construe 0 Site Plan including location <br /> AGENT ADDRESS VviS� gOI ADD ESSDr of well/septic <br /> (City,State,Zip) e,zip>. MI Setbacks <br /> ( <br /> ars�eevllle, WI 53954 <br /> PHONE PHONE 0 Site Plan approval from <br /> 608-516-9210 applicable township. <br /> E-MAIL ADDRESS E-MAI ADDRESS <br /> helnzmankraig @yahoo.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR CURRENT NING: AC GE: r2 Elevation of property <br /> ['PARCEL <br /> NUMBER 6 <br /> 11'1'1M-8050-0 -1 frontage drawn to scale. <br /> TOWNSHIP SECT <br /> Town of Cottage Grove i�N ,4: SE ,�a,4: Driveway permits <br /> (state,county,town) <br /> ADDRESS: n <br /> 2. t 9 5 �t p IA o c R 0 Sanitary permits <br /> CSM: 13642 LOT 1 SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> Potter ew CRIPT ON: <br /> Home ❑ Zoning District <br /> . 131This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 13-2017-00097 ❑ Rural Address <br /> EWER )EPTIC (new/existing) <br /> HEIGHT IN FEET: 31' 13/16" NUMBER OF STORIES: (Not ncluding basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 2030 1ST FLOOR: 2968 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ♦ filling/access) <br /> 1082 6080 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -0. ♦ -► ♦ -i $ 499,500.00 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? EJYes ONO ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres alo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ✓Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes alo <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 ✓N° ['Don't know <br /> 7. Is this to correct a violation? [JYes ✓INo <br /> fa& I S— APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -4, -+ -► <br />