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DANE COUNTY ZONING PERMIT Page 1of2 <br /> DCPZP20 6-00424 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GRUNDAHL REV TR,JEFFREY A&MARY L (608) 576-7850 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 10964 COUNTY HIGHWAY A <br /> (City,State,Zip) (City,State,Zip) <br /> HOLLANDALE, WI 53544 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-271-8600-0 TOWN OF BLUE MOUNDS 27 NE NW <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10101 BARTON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12585 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (4)Agriculture 6 Description:SFR WITH PORCHES 101 - SFR (detached) <br /> District <br /> Category m Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> Other: <br /> Private 13-2015-00294 <br /> ROAD CLASSIFICATION REZONE NO C.U.P.NO VARIANCE NO DEED RESTRICTION <br /> C-Town Road 9899 ❑ YES NO <br /> SHORELAND See It FLOOD IftwE WETLAND EC/SW NO. <br /> Utr- YES d NO ❑ YES © NO ❑ YES ® NO EC2015-0344 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 8278 <br /> 28 Sq.Ft.2723 Sq.Ft.4715 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $750,000.00 <br /> 2 Sq.Ft.840 Sq.Ft PERMIT FEE <br /> $670.85 <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 SIGNA : e. Iles • • t--� DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. + _ - -7—///„- - <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/11/2016 PMK2 <br /> ❑ Y S ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />