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Ap.libation Number:APP-34347 <br /> - DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090241 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME 'PHONE <br /> LAVERNE MAIER (608)798-3268 GILLES CONSTRUCTION 608-220-9841 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 5842 COUNTY HIGHWAY P 1509 MONTICELLO LN. <br /> (City,State,Zip) (City,State,Zip) <br /> CROSS PLAINS,WI 53528 WAUNAKEE,WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0808-172-9210-0 SPRINGFIELD 17 NW SW <br /> Mil:7K•1»ai-/A 11 01:1*HIM HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 7646 KICKABOO RD <br /> LOT BLOCK C.S.M.NO.Qr PLAT NAME <br /> 1 CERTIFIED SURVEY MAP: CSM 12687 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: W New ❑Addition/Alteration CENSUS CODE <br /> RH-1 2.31 Description:SINGLE FAMILY RESIDENCE W/DECK 101 - SFR <br /> CATEGORY XI Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑other: ❑Public Private 518287 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C 10024 ❑Yes ❑No <br /> SHORELAND FLOOD ZONE �t WETLAND EC/SW NO. <br /> Xj Yes ❑No ❑Yes X]►No ❑Yes X No <br /> HEIGHT(In Feet) BASEMENT 1.FLOOR TOTAL SQUARE FEET <br /> 2095 3764 5859 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 300,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. $ 489.00 <br /> 1. I,the Undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN i URE: Owner/Agent D•TE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit (� _ � <br /> v `` _ ■ if_ • <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> r Ye ❑No 26 May 2009 DJE1 <br /> LA DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: S._ <br /> OF 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE <br /> Conditions: PROJECT RE• RES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF ' 'Yi��� (CATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. <br /> INITIALS <br /> 2. ERO�:i N CONTROL: OWNER/AGENT , UST CONTACT THE DANE COUNTY DEPARTMENT OF <br /> LAND&WATER RESOURCES(608- 4,-3(47)TO H'i E I 'ETERMINED IF AN ERCrSI N CONTROL■ <br /> PERMIT IS REQUIRED. SIGNATURE A_ j• i4„ .I. i /' DATE / y <br /> 545-112(12/05) GCS-sin ��" � ` ^-t <br />