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ZOMNG PERIVIT /t UC TION ac ' SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Chad and Michelle Fuller <br /> ❑Zoning Status; CUP; <br /> OWN A QRES e� eet,Cay, e,zip) Deed Restriction;CSM <br /> 8446 �'Inei�Yd ross t gains, WI 53528 <br /> Variance(# ) <br /> HOME PHONE CEJ�O,tiO,[10-0893 E-MAIL ADDRESS <br /> Ej tf �j full3r4 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> ENT ME NT OR NA <br /> 151V/rag Construction LLC caal aag Construction LLC ❑Site Plan including location <br /> Mg St C b NTTralrle ORADDRESS t of well/septic <br /> ounet oreb, WI 53572 (Vaunt' oreb, WI 53572 ❑Setbacks <br /> ( <br /> PHONE PHONE ❑Site Plan approval from <br /> 608-220-0297 608-220-0297 applicable township. <br /> DDRESS DDRESS <br /> E-MAIL uan`iiaagconstruction @ gmail.com E-MAIL danhaagconstruction @gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT❑NUMBER PARbF�f IM�E -9205-0 CURRENT 7}Q 1NG: ACgE5GE: frontage drawn to scale. <br /> TOWNSHIP: ��JJ�� SECT O : i{ <br /> Cross Plains �' .3/4. o7N ,�4,�4: )7E/W ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> F4/4e-Lot 2 Pine Hill Rd Cross Plains, WI 53572 <br /> csM: 14655 LOT 2 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P OJECT pES RIP ION:, <br /> t+�ew sing5e uamlly home ❑ Zoning District <br /> This 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: 13-201700381 ❑ Rural Address <br /> EWER PIEPTIC (new/existing) <br /> HEIGHT IN FEET: 24 NUMBER OF STORIES: (Notncluding basement) <br /> ❑ Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> i 7 <br /> I. /k 6 6 3 Z� 4, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 538 s� <br /> 3RD FLOOR: q filling/access) <br /> s 1 q❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —► ♦ ♦ -i -► ♦ $ 420,000.00 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? ❑Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Elo <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 'lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 0No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />