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DANE COUNTY ZONING PERMIT ZONING PERMIT N0. Pagelof2 <br /> DCPZP-2014-00907 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CORY CHRISINGER (608) 576-9611 The House Doctors MD Inc. (608) 635-7604 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) , <br /> 6694 FAIRWAY CIR W8024 Morse Rd <br /> (City,State,Zip) (City,State,Zip) <br /> WINDSOR, WI 53598 Poynette, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> U , GUtr i-Si& . r tjohnson @housedoctorsmd.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0910-293-6364-0 TOWN OF WINDSOR 29 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4369 Bent Grass CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 34 PRAIRIE CREEK SUBDIVISION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Now Structure/Addition CENSUS CODE <br /> R-4 Residence .4 Description'sfr 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> ❑ Other: Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 9079 <br /> ❑ YES [Z] NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR . TO',V_SQ.JA1 E FEE f <br /> N 95 k"cPY Sq.Ft. 1047 Mr6 sq Ft.2013 ���? <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $260,537.00 <br /> 2 Sq.Ft.906 Sq.Ft. PERMIT FEE <br /> $347.45 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of J <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 constrluc!ien <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 ooh- a, es. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN. 5?.finer/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or `' <br /> plans submitted will invalidate the permit. / /)--/9 <br /> OFFICE USE JNLY 1"(fgrmy►t11.4 I/ I'. <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/05/2014 SCW1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 3 <br /> TV./Cr (A)I I ())(t; V(,k- 6a, ii ( ta(-i\( 4/1 -lic 1c4-- ,Q4/1/La 1 i <br />