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DANE COUNTY ZONING PERMIT DCPZP 2017 00406 Page1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DENNIS R RIBBLE (608) 658-9958 Black Wolf Construction LLC (715) 209-2068 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5600 LEXINGTON ST UNIT#5 6185 County Line Dr., <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 Rosholt, WI 54473 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> doug @blackwolfcontraction.corn <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-231-9710-0 TOWN OF DEERFIELD 23 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3815 Ridge LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13756 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (2)Agriculture 3.881 Description:sfr w/covered porch 101 -SFR (detached) <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13201700193 <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10036 D YES ® NO <br /> • <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO ❑ YES IO NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4125 <br /> 13 Sq.Ft. 1645 Sq.Ft.2480 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $238,310.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $359.38 <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 SIGNATURE: Ow"/A nt DAT <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. . a / t � 1 7 6 ,)?U/' <br /> OFFICE USE ONLY (form ver3ion 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/06/2017 SCW1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 4 p;"1 <br />