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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 /> Marlene J Kreuger or Dale Kreuger oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Ni72298 Rinden RD Cottage Grove,WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)712-3214 I e Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Michael Grob Grob Construction LLC igait3lan including location <br /> GENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3761 Skyhigh Rd 3761 Skyhigh Rd <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Cottage Grove,WI 53527 Cottage Grove,WI 53527 <br /> PHONE (608)770-5806 PHONE [](608)839-5806 ape. e township. <br /> E-MAIL E-MAIL ADDRESS E-MAIL ADDRESS <br /> grobconst @gmail.com grobconst @gmail.com r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: evation of property <br /> []PARCEL 061103395003 G4 G5 G5M 7 41.300 frontage drawn to scale. <br /> NUMBER j�,�� x <br /> SHIP: SECTION: r' <br /> Pleasant Springs -6-11fr s +/4_ sw +/4%: so ind V Q e pe its <br /> ADDRESS: (state, ty,town) <br /> 2298 Rinden RD Cottage Grove , WI 53527 its Wa e,� <br /> CSM: None LOT None SUBDIVISION BLOCK/LOT N I l� 1 <br /> None None ubli vate /VIrT , <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW P <br /> PROJECT DESCRIPTION: <br /> New Garage Expanded Dining Room Make One Elevation 3s_j" -)i-I Ing District <br /> . ❑This project is a new building or structure. laPerrriitt Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: !Address <br /> EWER [EPTIC ( ~i ng <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 12 feet one ❑ wetly -in/ <br /> S • attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosion••• 1• , it <br /> BASEMENT: None 1ST FLOOR: 773 + TOTAL SQUARE FOOTAGE: j ( :e rbanCe, <br /> S filling/ac ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> None None F/ c- 773 <br /> -� ❑ Review • I• Survey <br /> ESTIMATED CONSTRUCTION COST: —• '. -+ —• —• -+ 31,000.00 and a .'r - 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? []1'es ✓iNo EiDon't kno <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo []Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 3Yes D io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? []Yes ✓}io <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 1lo []Don't know <br /> 7. Is this to correct a violation? Elves []No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -I -4. <br /> 545-112(4ro8) <br />