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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 /> Deborah Peters ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2744 Bluebird Lane, Cottage Grove, WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)628-4822 (608)628-4822 dkpeters53@gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ 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:llaccessdane.co.diane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 071105150011 SDR-08 0.75 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> TO7NR11 E 5 1/4: SW 1/4; NE n Driveway permits <br /> ADDRESS: (state, county, town) <br /> 2744 Bluebird Lane, Cottage Grove, WI 53527 <br /> CSM: LOT SUBDIVISION BLOCK/LOT III Sanitary permits <br /> Elmargo Estates Lot 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Movable 12x20 shed ❑ Zoning District <br /> • ❑✓ This project is a new building or structure. U Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 11 .0 1.0 Li Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1sT FLOOR: ❑ ErosionControl permit <br /> 240.0 j. TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 240.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) --' .- -' -' -4. -' $ 5,300.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ❑No QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes LIN° <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) [✓ryes ' Vo ['Don't know <br /> 7. Is this to correct a violation? nYes ✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -to- <br /> REV <br /> -REV(61119) <br />