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SUPPLEMENT to Web-App If <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ashley Sweeney <br /> El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2715 S.Park St.,Cottage Grove,WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)774-5175 thissweeney @yahoo.com 15I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Josh Larson 4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> Madison,WI <br /> PHONE PHONE El Site Plan approval from <br /> (608) 220-6443 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> ❑PARCEL 046/0611-094-8850-9 R-1 DCPREZ-0000-06026 0.47 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Pleasant Springs 1/4: %4+/: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2715 S. Park St., Cottage Grove, WI 53527 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 7,643 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIIIW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . 19 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: ❑ Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2.0 0.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionCantml perm it <br /> BASEMENT O O 1ST FLOOR: 120.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 120.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and available options. <br /> -P(Please round to nearest dollar) $ 2,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Jlo EDon'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? QYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes INNo <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 ENo r4Don't know <br /> 7. Is this to correct a violation? ['Yes EjVo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />