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DANE COUNTY ZONING PERMIT DCPZG PERMI-00342 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT J FREDRICK (608) 219-9205 SUMNICHT CONSTRUCTION (608) 225-8255 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2618 STATE HIGHWAY 92 1387 COUNTY HIGHWAY U <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ROBERT.FRED/RICK @COMBINED.COM JDSUMNICHT @TDS.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0507-081-9550-6 TOWN OF PRIMROSE 8 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9019 BRITT VALLEY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 15.4 Description:SFR 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2016-00153 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10150 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5834 <br /> 13.5 Sq.Ft.2155 Sq.Ft.3679 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $500,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $487.55 <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 • • .nces. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN•TU- - : 0 er/Ag- , DATE: <br /> Ordinances.Any unauthorized change from the information o <br /> plans submitted will invalidate the permit. 6""/�o <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED 'INITIALS 1st INSPECTION DATE INITIALS <br /> 06/10/2016 HJH3 <br /> / ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: I�--Y' ( ^ /o ^ 'C, i'Mc <br />