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NO.DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 4 00906 Pagelof2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> HART FAMILYTR (920)251-6322 DEGNAN DESIGN BUILDERS (608) 846-5963 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2916 PEBBLE VALLEY CT 134 ETHUN PLACE <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 DEFOREST, WI 53532 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HARTS4 @ATT.NET AMY @DEGNANDESIGNBUILDERS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-194-7076-2 TOWN OF BRISTOL 19 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address is 2916 PEBBLE VALLEY CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 6 PEBBLE VALLEY <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition <br /> R-1 Residence 2.2 Description:24'x 40'HOME ADDITION CENSUS CODE <br /> District �3B Garage <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT r.0 <br /> ❑ Other. Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO, DEED RESTRICTION <br /> E-All Other 2136 <br /> ❑ YES k) NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 0 NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 960 <br /> 14 <br /> Sq.Ft. Sq.Ft.960 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR S50 030.03 <br /> 1 Sq.Ft. Sq Ft. PERMIT FEE — I <br /> . <br /> S122.00 <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 D. e County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordin_ '(es. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATU- ' ■wne .gent DATE: <br /> Ordinances.Any unauthorized change from the information or �',I /� / / <br /> plans submitted will invalidate the permit. a alai `/ IT/. <br /> OFFICE USE ONLY (form version 03.00,07) <br /> SURVEY REQU✓ *? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> // ❑ NO DATE� 12/04/2014 P M K2 <br /> REVIEWED INITIALS 2nd INSPECTION DATE CIT U,LS <br /> Initials: <br /> •/ --- <br />