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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 /> Joe and Lynn Hieman /Wing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2755 Mourning Dove, Cottage Grove, WI Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)839-5523 Site Plan d wn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an mclu dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Blatterrnan Built Homes, LLC Same •e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s <br /> 3 72 Old Meier Rd <br /> City,State,Zip) (City,State,Zip) etbacks <br /> Madison,WI 53718 <br /> PHONE PHONE Q Site P proval from <br /> (608) 279-5334 ap ' ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> klarsenaultl @yahoo.com F plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: [0....gpmeit n <br /> o of property <br /> QPARCEL 071105452409 R-1 '.))S 0.49 frontage drawn to scale. <br /> NUMBER t� <br /> /TOWNSHIP: SECTION: , <br /> v/ Town of Cottage Grove 1/.: +/.'A_ ❑Driveway perm <br /> ADDRESS: (state,county town) <br /> Lot 60 Mourning Dove i') 5 6 n ovrn i 0_4e Dr <br /> CSM: LOT 60 SUBDIVISION BLOCK/i,Qy anita ry p 'ts //�/ /!/✓ <br /> • <br /> Ravenwood Estates (publi��_.l <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW C <br /> PROJECT DESCRIPTION: ,��Y/ <br /> New Single Family Home ,� Zonin District <br /> . 12 This project is a new building or structure. !�d'Permi ed Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: , •ddress <br /> I—TEWER [EPTIC 13 )-`'I-7 ^ )S ( _-/'% Lltt /'' fisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement`) <br /> )1) . - , 24.0 1.0 Wetlan plain/ <br /> s, Shor n (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> Erosion OI permit <br /> BASEMENT 1ST FLOOR: TOTAL SQUARE FOOTAGE: (slopes turbance, <br /> 1,764.0 <br /> *./7761C '' fill' cces <br /> 2ND FLOOR: 3RD FLOOR: `� <br /> IIS- C) A, Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options <br /> (Please round to nearest dollar) '♦ 0 Q <br /> /. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓INo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies EINo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes Elio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Jo <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) Ekes QNo ✓Don't know <br /> 7. Is this to correct a violation? QYes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -i -► <br /> 545-112(4/08) <br />