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DANE COUNTY ZONING PERMIT DCPZP 2015-00106 Page of <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JACOB K BREUNIG (608) 370-6159 KEN BREUNIG 516-9002 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2016 TUMBLEWEED DR 6437 COLLINS RIDGE ROAD <br /> (City,State,Zip) (City,State,Zip) <br /> PRAIRIE DU SAC, WI 53578 DANE, WI 53529 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CJBREUNIG4 @GMAIL.COM MKBREUNIG3 @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0907-183-6077-0 TOWN OF ROXBURY <br /> 18 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7217 FLYHAWK LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 17 BLACKHAWK FIELDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 1.17 Description:4 BDRM SFR,FRONT PORCH,BACK DECK 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2015-00048 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 9814 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO ❑ YES ® NO ❑ YES la NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5582 <br /> 22 Sq.Ft. 1965 Sq.Ft.3617 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $350,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $468.65 <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 DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. „ • ,, LC: ' <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/18/2015 SJ W 3 <br /> //® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> $4nitials:�C�� <br /> (1.--q1 V V <br />