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DANE COUNTY ZONING PERMIT DCPZP 2015 00049 Pagel of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DALE EGEBERG (309) 829-7507 SHAW BUILDING AND DESIGN INC (608) 877-1131 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 15935 KINGSWOOD DR 3185 DEER POINT DR <br /> (City,State,Zip) (City,State,Zip) <br /> BLOOMINGTON, IL 61705 STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MDEGEBERG @GMAIL.COM CHRIS @SHAWBUILDERS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-192-6589-7 TOWN OF MIDDLETON 19 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7788 SUMMERFIELD DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 39 PHEASANT POINT I <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 1.54 Description:SFR+front porch+rear sun room 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2015-00027 9 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRIQTION <br /> E-AII Other <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES (0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR t/ 'TOTAL SQUARE FEET <br /> 27 Sq.Ft.2915 Sq.Ft.4503 <br /> 8998 <br /> PROJECT COST i <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $800,000.00 <br /> �v\V`S L1 PERMIT FEE <br /> ,i... g V-, (� Sq.Ft. <br /> 2 Sq.Ft.992 $724.85 <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 SIGNAT R wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information o� <br /> plans submitted will invalidate the permit 6 , c. -II_ J, <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED T DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑ YES ® NO 02/11/2015 SJW3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: G� <br />