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DANE COUNTY ZONING " ERMIT DCPZP-2015-00707 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS A SARBACKER (608) 630-'622 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1487 RANGE TRL <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SARB7 @TDS.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0508-034-8002-0 TOWN OF ONTROSE 3 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTIO STREET NAME ST.TYPE <br /> (Assignment of new address is 1487 RANGE TRL <br /> subject to field verification.) <br /> LOT BLOCK C.S.M. 0.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSE'PROJECT: Alteration to existing building CENSUS CODE <br /> A-1 Ex Exclusive Ag 29.3 Description: •EBUILD FIRE DESTROYED SFR 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Ag'cultural SEWER SANITARY PERMIT NO. <br /> ❑ Other Septic 16572 <br /> ROAD CLASSIFICATION REZONE NO, C.U.P.N.. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ❑ NO ❑ YES ® NO ❑ ES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5637 <br /> 20.5 sq.Ft.170• Sq.Ft.2847 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $260,000.00 <br /> 2 Sq.Ft. 108: Sq.Ft. PERMIT FEE <br /> $472.78 <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 pe ormed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply wit the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of t is permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for coma lying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. W. lands that are not associated with open water can be <br /> difficult to identify. Failure to comply may re•.ult 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 D-partment of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitte" 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 SIGN T n;; wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or ! I] <br /> plans submitted will invalidate the permit. 1 � •I� II q- <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/04/2015 HJH3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS p ✓ 2nd INSPECTION DATE INITIALS <br /> itia —V1-\ / 1 {� <br />