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DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 0019 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOEL F CLARK (202)215-5130 Custom Construction Builders Inc (608)798-4345 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5241 FRISCO CT 2809 Birchwood Pass <br /> (City,State,Zip) (City,State,Zip) <br /> MIDDLETON,WI 53562 Cross Plains,WI 53528 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Iisa.hclark @gmail.com CSt1'VVISR11 brutS,VIC,-1- <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 35 NE SE <br /> 0808-351-9791-0 TOWN OF SPRINGFIELD <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6642 GREENBRIAR RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 10548 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 1 Description:sfr w/cov frt por,2 at-grd patio,no decks 101 -SFR(detached) <br /> District <br /> Category ® Residential El Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: i3-)biL oa qa1 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2392 ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE ,�/ WETLAND EC/SW NO. <br /> ❑ if YES ® NO ❑ YES NO 0 YES NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5786 <br /> 32 Sq.Ft.1773 Sq.Ft.2585 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $450,000.00 <br /> 2 Sq.Ft.1428 Sq.Ft. PERMIT FEE <br /> $483.95 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 SIG '.TURE: • ner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or J O/ • � <br /> plans submitted will invalidate the permit. UV/aw . , ._ , A_ I� 1 <br /> OFF CE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED (4ITIA 1111W W. WI 1st INSPECTION DATE INITIALS <br /> 01/20/2015 RLB <br /> YES ® LS NO DATE REVIEWED INI � \ 2nd INSPECTION DATE INITIALS <br /> Initial + 1 i V'a,I 15 " ,�\ <br />