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DANE COUNTY ZONING PERMIT ZONING <br /> 2015700058 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DAVID L VOIGT (224) 629-6861 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 112 POTOWATOMI DR <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON,WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @dvoigt.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 36 SE NE <br /> 0512-364-1566-1 TOWN OF ALBION <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> POTOWATOMI DR <br /> (Assignment of new address is 112 <br /> subject to field verification.) <br /> - <br /> LOT I C.S.M.NO.or PLAT NAME <br /> 16 1BLOCK 6 I INDIAN HEIGHTS RESUBDIV!SION OF BLOCKS 3&6 EXCEPT LOT 13. BLOCK 6 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .286 Description:building new gabled dormer 434- Residential Addition <br /> District <br /> SEWER SANITARY PERMIT NO. <br /> Category ® Residential ❑ Commercial ❑ Agricultural Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv ❑ YES ® NO <br /> Streets <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 /> 365.3 <br /> 25.0 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES <br /> 2nd FLOOR 3rd FLOOR $35,000.00 <br /> 2 Sq.Ft.365.3 Sq.Ft. PERMIT FEE$77.40 <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 Count zoning inspectors for the <br /> purposes of determining compliance with the zoning ordin. a - . , ! <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: 0, ner/' 1 : DA E: <br /> Ordinances.Any unauthorized change from the information or I� <br /> plans submitted will invalidate the permit. ` ` <br /> OFFICE USE ONLY (form iersio')03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/16/2015 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />