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DANE COUNTY ZONING PERMIT DCPZP201500334 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LEO V MATTERN (608) 358-1814 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1057 ELDON WAY <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Imattern <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0512-054-9550-0 TOWN OF ALBION 5 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1057 ELDON WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 09667 <br /> '-ONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 4.27 Description:gazabeo 328-Other Non-Residential <br /> District <br /> ;ategory ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Private <br /> Other: <br /> DAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 7741 <br /> 0 YES ® NO <br /> -IORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> IGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 120 <br /> 12 Sq.Ft. Sq.Ft. 120 <br /> PROJECT COST <br /> OF STORIES 2nd FLOOR 3rd FLOOR $2,000.00 <br /> Sq.Ft. Sq.Ft. <br /> PERMIT FEE <br /> $59.00 <br /> le undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> ed on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> :omply with any provision or condition of this permit renders this zoning permit null and void and <br /> ject to enforcement action. <br /> knowledge that I am responsible for complying with State and Federal laws concerning construction <br /> r or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> ;ult to identify. Failure to comply may result in removal or modification of construction that violates <br /> aw or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> eby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> Dses of determining compliance with the zoning ordinances. <br /> &Agent hereby agree to comply with all Dane County SI ATUI 9 wner/Agent DATE: <br /> aces.Any unauthorized change from the information or e <br /> ubmitted will invalidate the permit. am _ _ 4 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> 'REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/26/2015 SCW1 <br /> 0 YES ® NO <br /> �v� DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />