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DANE COUNTY ZONING PERMIT DCPZP 2015 00002 Page 1 of 2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PH• AGENT/CONTRACTOR NAME PHONE VERIDIAN HOMES STB LLC ACKER BUILDERS, INC. (608) 850-6650 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 6801 SOUTH TOWNE DR 331 E. MAIN STREET, SUITE 104 (City,State,Zip) (City,State,Zip) MADISON, WI 53713 -. WAUNAKEE, WI 53597 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0708-203-2212-0 TOWN OF MIDDLETON 20 SW NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 7621 TIGER LILY CT subject to field verification.) LOT BLOCK I C.S.M.NO.or PLAT NAME 62 SPRUCE HOLLOW ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE A-1 Agriculture .7 Description:SFR WITH DECK AND PORCH 101 -SFR (detached) District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private 13-2014-00430 ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION E-AII Other ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 6970 28 Sq.Ft.2708 Sq.Ft.4262 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $582,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $572.75 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: OwnerlAgent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. / S 15 OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 01/05/2015 PMK2 AYE ❑ NO DATE INITIALS 2nd INSPECTION DATE INITIALS Initials: t, 17 !) 4