DCPVAR-2012-03638 - Laserfiche WebLink

Home Browse Search

DANE COUNTY ZONING PERMIT - DCPVAR-2012-03638 OWNER INFORMATION AGENTICONTRACTOR INFORMATION OWNER NAME PHONE AGENT /CONTRACTOR NAME PHONE G WILLIAM REMIS Rich Deegan (608) 712-1502 BILLING ADDRESS (Number, Street) ADDRESS (Number, Street) 853 RIDGEWOOD WAY N6588 County Highway E (City, State, Zip) (City, State, Zip) MADISON, WI 53713 Albany, WI 53502 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL • TOWNSHIP SECTION 1/4 1/41/4 0709-352-1043-0 TOWN OF MADISON 35 NW NE - • ' • • - HOUSE NO. ST. DIRECTION STREET NAME ST. TYPE (Assignment of new address is 853 RIDGEWOOD WAY subject to field verification.) LOT BLOCK C.S.M. NO. or PLAT NAME 15 5 1 OAK RIDGE SUBDIVISION - ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE Description: Street setback variance Category ❑ Residential E]Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Sewer ❑ other: ROAD CLASSIFICATION REZONE NO. C.U.P. NO. VARIANCE NO. DEED RESTRICTION ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES 0 NO ❑ YES NO ❑ YES ® NO HEIGHT (In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET Sq. Ft. Sq. Ft. PROJECT COST #Error NO. OF STORIES 2nd FLOOR 3rd FLOOR Sq. Ft. Sq. Ft. PERMIT FEE$350.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner & Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances. Any unauthorized change from the information or plans submitted will invalidate the permit. OFFICE USE ONLY 03.00 .07) SURVEY REQUIRED ? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 05/07/2012 ❑ YES ❑ NO DATE REVIEWED R W L 1 INITIALS 2nd INSPECTION DATE INITIALS Initials: