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DANE COUNTY ZONING PERMIT DCPZP-2016-00519 • P.uic 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PATRICK J MATSON (608)825-3102 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1617 ESKER TRL <br /> (City,State,Zip) (City,State,Zip) <br /> COLUMBUS,WI 53925 <br /> EMAIL ADDRESS E-MAIL ADDRESS <br /> patrickm@lsol.net <br /> PARCEL NO. TOWNSHIP SECTION 114 1141/4 <br /> 0911-121-00$8-0 TOWN OF BRISTOL 12 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1617 ESKER TRL <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 48 AR DRUMLIN CREEK <br /> ZONING DISTRICT P CEL ACREAGE PROPOSED PROJECT: Alteretibn to existing building CENSUS CODE <br /> A-1 Agriculture Description:15'x 14'deck addn to sfr 434-Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 0 YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> O YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 210 <br /> 1 Sq.FL Sq.Fl.210 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,000.00 <br /> 1 Sq.FL Sq.Ft. PERMIT FEE <br /> $65.75 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and subject <br /> to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams.Wetlands that are not associated with open water can be difficult <br /> to identify. Failure to comply may result in removal or modification of construction that vio the law or <br /> other penalties or Costs. For more information, visit the Department of Natural Resour age at <br /> www.dnr.state.wi.us or contact the Department of Natural Resources Service Cen <br /> I hereby consent to the entry on the permitted premises by Dane County zo ctors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT RE:Owner/A,ant DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will Invalidate the permit <br /> A ., ` _ s <br /> OFFICE USE ONLY (form vetslon('3.1)1.01)) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS let INSPECTION DATE INITIALS <br /> ►.+ m NO 09/15/2010 RIB <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial j ✓�T <br />