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DANE COUNTY ZONING PERMIT DCPZP 2016-00485 Pagel of <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE �q D <br /> DAVID M PERKINS (563)580-9313 Keuler Construction Incorporated 1`_ittlg� ”a-IM <br /> �� <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) �P� <br /> 2864 WINTERHAZEL LN 8308 State Highway 19 <br /> (City,State,Zip) (City,State,Zip) <br /> FITCHBURG, WI 53711 Cross Plains, WI 53528 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> melissajperkins @gmail.com keulerconstruction @hotmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0607-234-9795-0 TOWN OF SPRINGDALE 23 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2182 COUNTY HIGHWAY J <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14268 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 4.567 Description:sfr w/covered front porch,screen porch,open deck 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ <br /> Other: Private 13-2016-00215 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES is NO E C a 0/G - o©g f <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 7020 <br /> 32 Sq.Ft.2332 Sq.Ft.3577 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $640,000.00 <br /> 2 sq.Ft.1111 Sq.Ft. PERMIT FEE <br /> $576.50 <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 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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 ins rectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: s • •r/Age/ DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. , i i - / , -. - v)C <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/02/2016 RLB <br /> \ / ❑ a ® NO DATE REVIEWED INITIALS (� 2nd INSPECTION DATE INITIALS <br /> Initials/ �/I '.� .-' / Q y� j1/f��/� <br />