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DANE COUNTY ZONING ''PERMIT Page 1of2 <br /> DCPZP-2015-00778 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GILLES C CHAMPAGNE (608)209-2537 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 204 MICHELLE LN <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mainjim123@yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0910-122-9950-0 TOWN O' WINDSOR 12 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTI.N STREET NAME ST.TYPE <br /> (Assignment of new address is 7575 COUNTY HIGHWAY C <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.INO.or PLAT NAME <br /> 1 CSM 09659 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 2.513 Description:4 bedroom sfr+rear screen porch+covered entry 101 -SFR (detached) <br /> District <br /> Category ® Residential (] Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2015-00306 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> Y Q 7766 <br /> - LC1J.i R ❑ 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 /> 25 Sq.Ft.2005 Sq.Ft.2437 <br /> 4442 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $247,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $383.15 <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 or. ..nces. <br /> Owner&Agent hereby agree to comply with all Dane County SI I.NATU" •' •wrier/Agent D• E: <br /> Ordinances.Any unauthorized change from the information or 1 j� _ ,/ r')(// <br /> plans submitted will invalidate the permit. s •°• '`y( /f <br /> �+\ <br /> 0 <br /> OFFICE MME ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> YES ® NO 09/24/2015 SJW3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: f L- , ) `a 6 '' i. - p P1 ')A <br />