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DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 5 00141 Page1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION;. .>. :i. -; <br /> OWNER NAME 1,�g. 41 ursovk PHONE AGENT/CONTRACTOR NAME ,PHONE <br /> RANDY FARNSWORTH :n5 t,LL (608) 220-9982 RICK FARNSWORTH 1603) X75-31: ;; <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) r <br /> 1801 COUNTY HIGHWAY W 446 COUNTY 1 gtiway g e <br /> - <br /> (City,State,Zip) ~(City,State,Zip) tr— <br /> STOUGHTON, WI 53589 MARSHALL, WI 53559 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> FARNSBLDR @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0612-311-8225-0 TOWN OF CHRISTIANA 31 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address is 1801 COUNTY HIGHWAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13664 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-1 Rural Homes 2 Description:garage,front porch,2nd floor studio addition 434- Residential Addition <br /> District <br /> Category ® Residential 0 Commercial 0 Agricultural SEWER SANITARY PERMIT NO <br /> 0 Other: <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 10569 ❑ YES ES NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> D YES VI NO ❑ YES ® NO I] YES © NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR I C' S:1, - — — <br /> 25 Sq.Ft. Sq Ft. 1044 — ---_--_---- <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $10,000.00 <br /> 2 Sq.Ft.720 Sq.Ft. PERMIT FEE <br /> $182.30 <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 arid Federal laws concerninc; Cons' .1(;!'(,r1 <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 Dano County SIGNATURE: Owner/• sent D E: <br /> Ordinances.Any unauthorized change from the information or .� 5//� <br /> plans submitted will invalidate the permit. i <br /> OFFICE USE-ONLY f«a` c .t v -." ` :-,r�f.;. ' ` 14, <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE ITALS® NO DATE REVIEWED INITIALS 2nd INSPECTION DALE <br /> Initials: <br />