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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2015-00105 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RYAN J JOHNSON (608)719-8074 Malibu Pools (608)575-6188 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4531 NINA LN 7182 State Highway 14#1207 <br /> (City,State,Zip) (City,State,Zip) <br /> MIDDLETON,WI 53562 Middleton,WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> johnson_ryan @me.com tcmalibupools @tds.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-081-2166-0 TOWN OF MIDDLETON 8 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4531 NINA LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 16 SUMMIT PASS <br /> ZONING DISTRICT 'PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE <br /> A-1 Agriculture Description:44'x 18'x 1'in grd pool 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES (A NO ❑ YES ❑ NO ❑ YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 792 <br /> 1 Sq.Ft. Sq.Ft.792 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $20,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $109.40 <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 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 SIGZURE: ner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or ( /��� 1 <br /> plans submitted will invalidate the permit. r -`!'lam`t b q S 3 -t FJ - �S <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/18/2015 RLB <br /> ji DATE REVIEWED® NO <br /> \/ • EWED INITIALS / 2nd INSPECTION DATE INITIALS <br /> Initials:Y • V1)10\1(i X111 <br />