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DANE COUNTY ZONING PERMIT DC ZONING PER 5 MIT NO.-00769 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GARY TRULSON (608)44319531 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 727 OAK DR <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TRULSONG911@YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0512-191-9500-2 TOWN IFFALBION <br /> 19 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 727 OAK DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.''INO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSE PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 40 Description:residential accessory use 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> D Other: <br /> Private <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 IA NO ❑ YES ® NO <br /> I <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4800 <br /> 28 Sq.Ft. Sq.Ft.4800 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $115,955.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $410.00 <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 nformation, visit the Department of Natural Resources web , <br /> ww <br /> page at w.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitt4d premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with tht zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/A t DATE: <br /> Ordinances.Any unauthorized change from the information or 1 t] -2 2 J� <br /> plans submitted will invalidate the permit. A - . / <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/22/2015 SJ W 3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials:_ <br />