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DANE COUNTY ZONING PERMIT ZONING ERMITOONO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> TIM 0 BRIEN HOMES (608)661-1105 SUE FROHLING (608)661-1105 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4868 HIGH CROSSING BLVD <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SFROHLING @TOBHOMES.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0910-294-2228-0 TOWN OF WINDSOR 29 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6666 DUSKY GLN <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 68 WOLF HOLLOW <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-2 Residence 0.36 Description:3 BEDROOM SFR+FRONT PORCH(NO DECK) 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> El other Public 6213 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-AII Other 9229 <br /> YES IO NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 16 Sq.Ft. 1504 Sq.Ft.2336 <br /> 3840 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $197,355.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $338.00 <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 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 SIGNATURE: Owner/Agent DAT : <br /> Ordinances.Any unauthorized change from the information or , <br /> plans submitted will invalidate the permit. • /f//.S <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INS- CTION DATE INITIALS <br /> 02/17/2015 SJW3 <br /> ® YES ❑ NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 6) ' I& J i jk) <br />