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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> John Klaus <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> 2730,Gaston road, Cottage Grove,Wisconsin, 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)839-3173 (608)332-7554 jklaus99@yahoo.com ❑✓ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Self Self El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Ei Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑✓ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accossdano.co.dano.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: El Elevation of property <br /> ElPARCEL 018/0711-051-8830-2 SFR-1 1.23 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION: <br /> • Cottage Grove 14: V4: ❑Driveway permits <br /> ADDRESS (state, county,town) <br /> 2730 Gaston road, Cottage Grove, WI, 53527 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition of first level deck attached to front of house at front entry ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑✓ This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - LI Rural Address <br /> DEWER rEPTIC 13,385 <br /> _ (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2.3 0.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 0.0 184.0 <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0 0 3RD FLOOR: 184.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 3,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres QNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres ❑No ['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 QNo <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 QNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -* <br /> REV(01/19) <br />