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DANE COUNTY ZONING PERMIT Page 1of2 <br /> DCPZP20 6-00305 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DONALD C TIERNEY Tm Obrien Homes of Madison LLC (608) 661-1100 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3564 EGRE RD 2601 Crossroads Dr., Ste. 140 <br /> (City.State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 Madison, WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sfrohling @tobhomes.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-303-6304-0 TOWN OF BRISTOL 30 SW SE <br /> PROPERTY ADDRESS HOUSE NO ST DIRECTION STREET NA �� ST TYPE <br /> (Assignment of new address is 3051 Laymans ) RUN <br /> subject to field verification.) �._ <br /> LOT BLOCK C.S.M.NO or PLAT NAME <br /> 14 BRISTOL GARDENS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture .696 Description:sfr w/porch 101 - SFR (detached) <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> ❑ Other. <br /> Private 13201600084 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED RESTRICTION <br /> E-All Other ❑ YES q NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES p NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4750 <br /> 20 Sq.Ft. 1285 Sq.Ft.2224 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $280,000.00 <br /> 2 Sq.Ft. 1241 Sq.Ft. PERMIT FEE <br /> $406.25 <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 ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County GNAT RE: Ow er/Agent ATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ■ Gt r • G'/0L j,C <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st IN PECTION DATE INITIALS <br /> 06/01/2016 SCW1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> 4,....-------- <br /> Initials <br />