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DANE COUNTY ZONING PERMIT DCPZGPERMI-00849 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHAEL BASAK (847) 334-5425 WISCONSIN LANDSCAPES INC (608) 437-3662 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 606 COUNTY HIGHWAY H 10921 SPRING CREEK RD <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 BLUE MOUNDS, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MICK @WISCONSINLANDSCAPES.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0506-223-9145-7 TOWN OF PERRY <br /> 22 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 606 COUNTY HIGHWAY H <br /> subject to field verification.) <br /> LOT BLOCK C.S.M. O.or PLAT NAME <br /> 1 CSM 04729 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-1 Rural Homes 2 Description:"eplace existing front porch landing-40"x 14' 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 3491 ❑ 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 /> 46.67 <br /> 32" Sq.Ft. Sq.Ft.46.67 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $2,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $53.50 <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 wish the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of his 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 ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA -E. • 'gent DATE: <br /> Ordinances.Any unauthorized change from the information or `� !`r�, <br /> plans submitted will invalidate the permit. Z[4 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/16/2015 SJ W 3 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial 10 1 9 1S M K <br />