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DANE COUNTY ZONING PERMIT DCPZP20i6o0578 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEFFREY C BALL (608) 213-9068 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) ' <br /> W8976 COUNTY HIGHWAY C <br /> (City,State,Zip) (City,State,Zip) <br /> FT ATKINSON, WI 53538 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeffball61 @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0712-244-9270-0 TOWN OF DEERFIELD 24 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 81 Fair Oak RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 4 CSM 14089 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 4.85 Description:detached accessory bldg.-no sanitary fixtures 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> Private no sanitary fixtures <br /> ❑ Other <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ID YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6720 <br /> 22 Sq.Ft. Sq.Ft.6720 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $210,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $554.00 <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 bn 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 SIG I'" . : fi,. • -r/A; -nt BATE: <br /> Ordinances.Any unauthorized change from the information or ,�L, <br /> //j 61.-2 �� <br /> plans submitted will invalidate the pee t permit. !l1 i\ <br /> r► <br /> OFFICE l!SE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/02/2016 SCW1 <br /> ® YES ❑ NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initi <br />