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DANE COUNTY ZONING PERMIT DCPZP 2016-00627 Page oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ERIN B DAMMEN (608)220-7235 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5571 RALPH RD <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON,WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> erindammen @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-164-6258-3 TOWN OF OREGON <br /> 16 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 5571 RALPH RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 28 HILLCREST HEIGHTS-1ST ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3 Residence (� Description:Att gar,open deck&steps,dining rm,stor rm addn to 438-Garage <br /> District a sfr <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PEI MIT NO. <br /> ❑ Other: Private f e 1./e. r <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E .�11 tTt r <br /> dcprez-2016-11017 7 ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE I WETLAND /� EC/SW NO. <br /> 111 YES NO O YES <br /> ❑ YES ® NO �WI/f NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 952 <br /> 26 Sq.Ft.252 Sq.Ft.700 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $80,306.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $121.40 <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 inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Own- /Agent DATE: <br /> Ordinances.Any unauthorized change from the Information or <br /> plans submitted will invalidate the permit. / 2/ /,. <br /> OFFICE US°ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? . DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/21/2016 RLB <br /> 1� ES ® NO DATE REVD )co INITIALS �� 2nd INSPECTION DATE INITIALS <br /> Initial (T\1 ^ <br />