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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2014-00497 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRETT M OFTENDAHL (608) 848-6165 HANSEN BUILDERS (608) 849-4736 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2865 INTERLAKEN PASS 110 BAKEN ST SUITES B <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53719 WAUANKEE, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> hansenbuilders@tds.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-183-9199-0 TOWN OF MIDDLETON 18 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4052 TIMBER LN <br /> subject to field verification.) • <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 2 CSM 12123 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 1.507 Description: 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2014-00214 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6282 <br /> 28'-6" Sq.Ft. 1887 Sq.Ft.3423 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $370,000.00 <br /> 2 Sq.Ft.972 Sq.Ft. PERMIT FEE <br /> $521.15 <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 <br /> subject 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 <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIG TURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. �y <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS Ise S C t DATE <br /> 07/23/2014 SSA1 <br /> zy YES ® NO DATE REVIEWED INITIALS 241/11141°4 A INITIALS <br /> Initials: //V 3■ 14 <br /> •`r <br /> -6� 1 C ice`c5 ��'�J( <br />