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r /6 r___ s-I ? <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Patrick Matson A .... <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 1617 Esker Trail Columbus WI 53925 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)825-3102 (305)720-7167 patrickm @Isol.net !� Site Plan drawn to scale /y�, / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME n <br /> none none girl Site Plan including locatio / <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> b/25"/0-0/.5.8 <br /> (City,State,Zip) (City,State,Zip) i,/ Setbacks '' <br /> PHONE PHONE "Site Plan approval from 4 <br /> applicable township. A <br /> E-MAIL ADDRESS E-MAIL ADDRESS a Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) f 4 <br /> PARENT P CEL NUM R: cp CURREN ZONING: ACREAGE: arElevation of property <br /> El PARCEL i�I /.—DQ l0 <br /> NUMBER A1� *r 0.90 frontage drawn to scale. ft/ --g-S2 <br /> I <br /> TOWNSHIP: SECT�} , G , , ]►r� Driveway perm <br /> Bristol v 4: I Y j (state,counttow <br /> ADDRESS: <br /> 1617 Esker Trail Columbus WI <br /> trSanitary•- ••' <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, e <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> 14 ft X 15 ft ground level unattached deck by screen porch Zoning District <br /> . DThis project is a ne • • •• ,g or structure. Permitted Use? 0�4_ 0/d ik <br /> his project is -• :dditio - teration to an existing building or structure. V <br /> SANITARY SERVICE: PERMIT NUMBER: Rural A•`,,. <br /> ,�,/ new/e •T <br /> EWER <br /> OPTIC X HEIGHT IN FEET: / i�l NUMBER OF STORIES: (Not including basement) ;•e/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: '• ' (attachment) �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) EroslonControl permit e>-36 <br /> BASEMENT: 1ST FLOOR: <br /> / d 4,TOTAL SQUARE FOOTAGE: ,, - slopes,disturbance, 712 t <br /> filling/access) / <br /> 2ND FLOOR: 3RD FLOOR: Z— / /f� 4r, <br /> (J Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. �� <br /> (Please round to nearest dollar) $ 1,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eyes EiNo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? E Yes :io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [✓Yes DI■lo <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) QYes "lo ['Don't know <br /> 7. Is this to correct a violation? ['Yes ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —1 —► <br /> 545-112(4/08) <br />