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DANE COUNTY ZONING PERMIT Page 1of2 <br /> :=03 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STEVEN L FRAME (608) 767-3393 QUALITY WEST CONSTRUCTION INC (608) 219-9163 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3565 RYAN RD PO BOX 12 <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DHCOWS @TDS.NET QUALITYWESTINC @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0706-304-8810-0 TOWN OF VERMONT 30 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTI4 STREET NAME ST TYPE <br /> (Assignment of new address is 3643 RYAN RD <br /> subject to field verification.) I <br /> LOT BLOCK I C.S.M. O.or PLAT NAME <br /> 1 CSM 13988 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSE PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (8)Agriculture 8.98 Description: FR(GARAGE NOT INCLUDED IN PERMIT) 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Septic 13-2015-00296 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.N¢. VARIANCE NO DEED RESTRICTION <br /> C-Town Road 19793 ❑ YES QJ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ® YES ❑ NO ❑ YES ® NO SEC-15-275 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 3556 <br /> 16 Sq.Ft.945 Sq.Ft. 1666 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $310,000.00 <br /> 2 Sq.Ft.945 Sq.Ft. PERMIT FEE <br /> $316.70 <br /> I, the undersigned, am the owner of the proprty or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be per`ormed, 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 tiis permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for comilying 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 Dlepartment 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 SIGNATURE/Ow -r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. - <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/17/2015 HJH3 <br /> YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />