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ZONING PERMIT APPLICATION �wlww.countyotdane.com SUPPLEMENT to Web-App S <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Kurt Fern rite <br /> Zoning Status; CUP; <br /> OWNER ADDRESS i Number.Street.City.State.Zip; Deed Restriction; CSM <br /> 4550 American Way, Cottage Grove, WI 53527 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 839-4202 (608) 576-7725 I kfemrite@danielsco.com n Si}e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 1 CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS I CONTRACTOR ADDRESS of well/septic <br /> (City State,Zip) 1(City.State.Zip) n Setbacks <br /> PHONE 1 PHONE ' fn Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL_ADDRESS <br /> 1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpN/accessdano.co.dane.wi.us/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: IACREAGE: <br /> ri PARCEL <br /> I c ie 0 7 1 1 `D szi 40 �9'��,,i: s F-12___0-0 F ( <br /> 1 O I F-+c/ frontage drawn to scale. <br /> TOWNSHIP. SECTION: <br /> (4bi: V ,).c 1 G 3 '/o: 5 r '/4: 7>i ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> LI ScS4r' c 2-t c.--{`a'-i ,.l a 1 ❑Sanitary permits <br /> CSM: I LOT SUBDIVISION I BLOCK/LOT <br /> r (public, private) <br /> l 1 Art V''.-.9-..k C.,Y'w L'4-tilt/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT InstallingEan above ground pool 24' DIAMETER, 12' RADIUS CIRCLE ❑ Zoning District <br /> . „ This project is a new building or structure. LI Permitted Use? <br /> 11]This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER. ❑ Rural Address <br /> EWER KTEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 4.3 ❑ 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: t ST FLOOR r ❑ ErosionControt permit <br /> I 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> I filling/access) <br /> 2ND FLOOR: I3RD FLOOR:I 452 0.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -i -i 3279 and available options. <br /> I (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes tNo LIDon't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes 7/-1No PDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? P.-Yes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes nNo <br /> 5. Is this project associated with a rezone.CUP/variance (petition/appeal I# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Eyes ENo LIDon't know <br /> 7. Is this to correct a violation? nYes E✓No <br /> $95.20 APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -- —s <br /> R_'', J1.'4 <br />