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DANE COUNTY ZONING PERMIT DCPZP 2015 00070 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOSHUA TARKENTON (608)438-1910 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2270 SAND ROCK RD <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jtarky @yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-242-9050-6 TOWN OF BLUE MOUNDS 24 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2270 SAND ROCK RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 3 I CSM 06621 • <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 5.667 Description:2 bedroom and 1 bath addition 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ,--1 <br /> ❑ Other: <br /> Private letter <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 5174 ❑ YES l21 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 /> 528 <br /> 12 Sq.Ft. Sq.Ft.528 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $20,000.00 <br /> 1 I Sq.Ft. Sq.Ft. PERMIT FEE <br /> $89.60 <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 SIGNATUR ------1W---- <br /> Ordinances.Any unauthorized change from the information or / 4-------- <br /> plans submitted will invalidate the permit. <br /> ae <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/26/2015 SSA1 <br /> �❑ YES 0 NO DATE REVIEWED INITIALS{� 2nd INSPECTION DATE INITIALS <br />