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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Vie5 ' 4 N i CaL e HAW C.-2_Sr-- J n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> _So hint1 i 11 &t . 'b CC- l ?, W i 53.5- 1 Variance(# 11629 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Wes (rla-4,9. -518 3 ❑Site Plan drawn to scale <br /> AGENT INFORMATIONCONTRACTOR INFORMATION and includes dimensions <br /> AGENT4 COI` Pim,i Lim i'u ivlt <br /> Chris Miller Construction LLC Chris Miller Construction LLC <br /> ❑ Site Plan including location <br /> AGED T ADDRESS 1 nne} COt TRACTOR AdElikitcl. of well/septic <br /> Cottage Grove,Wi 53527 Cottage Grove,Wi 53527 <br /> 1 <br /> (City,late Zips) ..,._.J (Citystate,zips , _ _. ___ -- n Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> 688 (c._ i. 1 O cp applicable township. <br /> E-MAIL ADDRESS ,. E-MAIL ADDRESS <br /> CI r i S, M , I (cti—, c, s"c'LICA't r rnCL.1 �.Com-, IT Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ri PARCELNUMBER :J7 12-_3 32 O IAO R'g" 2. 2.4o` C frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .F rt C-1...12 1/4: '/41/4: n Driveway permits <br /> ADDRESS: (state, county,town) <br /> 992 NULAND RD <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ['Sanitary permits 4 BE DF OOM <br /> 15'1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ca 11.36;i-A A1-krre ❑ Zoning District <br /> • I"fhis project is a new building or structure. ❑ Permitted Use? YES <br /> IIIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address NEW <br /> EWER 1 '. � <br /> EPTIC I Z 2a -` `-' 2 <br /> d 1 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2-r2- 1. 1:3Wetland/Floodplain/ NO <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 >1 2 5 <br /> 1 o-7 3 <br /> 25 4, TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR:O filling/access) EC2021-0226 <br /> LI.9-3 2 ,, <br /> ❑ Review Location Survey no <br /> ESTIMATED CONSTRUCTION COST: -0. --i.- I $ 5� �� and available options. <br /> (Please round to nearest dollar) I / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 12No ❑Don't know <br /> 2. IS there a wetland or floodplain on or near the property? Yes XIV o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? yYes ONo <br /> 4_ Has there been a zoning permit issued for this property in the past 5 years? rlYes MN <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) FlYes ENo 10 Don't know <br /> 7. Is this to correct a violation? Utes EiNo <br /> $543.20 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -♦ —o- <br /> 545-112 <br /> ►545-112(4108) <br />