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ZONING PERMIT APPUCATION www.countyofdane.com SUPPLEMENT to Web App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> RG Huston Company Inc (Brad Huston) 'Z- <br /> oning Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 4026 County Hwy N Cottage Grove WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)209-6646 bhuston©rghuston.com [jte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> La Crosse Sign Group La Crosse Sign Group site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2242 Mustang Way 2242 Mustang Way � f E <br /> (City,Ste, ) (City,State,Zip) Setbacks <br /> Madison WI 53718 Madison WI 53718 4kl"'om <br /> PHONE PHONE Site Plan approval from <br /> (812) 841-2742 (812) 841-2742 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kathryne.kippeselacrossesign.com kathryne.kippes@lacrossesign.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.ust) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> QPARCEL 018/0711-212-8000-1 C2 (p,12- frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • TO7NR11E 21 % NE 1 IA: NW 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3951 County Hwy N Cottage Grove WI <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> SUBDIVISION <br /> 3,344 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Replacing ground sign on property ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [)EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ VVetland/Floodplain/ <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 /> T. •—.-. - •• .• . (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> - filling/access) <br /> ■ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ • a a 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? QYes ao N.s•n't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o 'Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ao <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) [i/]Yes o [on't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112 taros (Continue on Back) -4. –e• - <br />