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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME , ! 3 <br /> Erik Maursetter /��F - <br /> Zoning Status;CUP, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM ,S^, <br /> 2842 Pleasant View Hts , Cottage Grove WI 53527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 838-8838 (651) 216-3427 ejmaursetter @gmail.com El Site Plan drawn to scale '"i <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions e <br /> AGENT NAME CONTRACTOR NAME <br /> Ezra Bontrager ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic I g(1Ji <br /> W5111 Barry Rd C ?/�d il.,_ `© <br /> (City,State,Zip) (City,State,Zip) 0Setbacks T� <br /> Dalton, WI 53926 <br /> PHONE PHONE _ Site Plan approval from 60k <br /> (920) 767-1383 applicable township.4/k <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> N/A Floor plans to scale z <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Fly Elevation of property <br /> PARENT PARCEL NUMBER: C RRENTZONIN ACREAGE: �1°� N, <br /> ElPARCEL R�_3 Oe �E z G �c�eS frontage drawn to scale. <br /> NUMBER !� i •7/ -323' ' ,.•' r A„ r -, /, �-J <br /> TOWNSHIP: SECTI•N: <br /> C.e-i-1-et q Gv'ove 2— '/' 5' V 14%, 5 �� ra Driveway permit rr <br /> 4' (state, county,) <br /> ADDRESS: <br /> Z(ae-iZ PfeQsctw+vuL)- > Es C ar2 6soue , 63527 A- anitary pekulik, is <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,pj <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / r. <br /> Pe 10 Baer, — yp t x Co`I ( x 24 Zoning District <br /> . 12 This project is a new building or structure. Permitted'Use? 3�27 <br /> This project is an addition/alteration to an existing building or structure. r0 '�' <br /> SANITARY SERVICE: �/(' PERMIT NUMBER: /== Rural Ad• -ss <br /> EWER I/�6EPTIC N/t (new ) <br /> HEIGHT IN FEET: """�� NUMBER OF STORIES: (Not including basement) <br /> Z� r' I gWetl-•• Floodpiain/ <,i_1�� <br /> �'i_ = :'�• =ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: g_ErosionCOntrol permit - <br /> N/A „ . '. 2,560.0 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, '1 . <br /> filling/access) A <br /> 2ND FLOOR: 3RD FLOOR: 2,560.0 <br /> ��p'� N�� d, Review Location`Survey c A 0 - <br /> ESTIMATED CONSTRUCTION COST: and available options. O' <br /> n ‘-� <br /> (Please round to nearest dollar) ♦ .- -. ♦ $ 25,000.00 V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IJYeslo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes I�jI ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El1'es HI()—a Tkty sew( 0...t <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies EINo 44 11°' <br /> 5. Is this project associated with Cci<Y`I ID (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ✓�V QDon't know <br /> 7. Is this to correct a violation? Yes DNo <br /> AUG 1 7 2015 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) DANE Comm PLANNING&DEVELOPMENT -+ -► -� <br />