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DANE COUNTY ZONING PERMIT ZONING P2 PERMIT i:, 4 0 ,1 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHAEL H JENSEN (608)838-4862 Rite-Way Const LLC (608)712-5601 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3272 MANSION CIR 2384 Vernon Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND,WI 53558 Stoughton,WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dhriteway @aol.com dhriteway @ aol.com — <br /> PARCEL NO. TOWNSHIP SECTION 1/4 /° 1': <br /> 36 SE NE <br /> 0710-364-0321-8 TOWN OF BLOOMING GROVE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME Si. PrI I <br /> (Assignment of new address is 3272 MANSION CIR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 21 FREEWAY MANOR <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-1 Residence .527 Description:14 x 15 deck addn w/1 step 434 - Residential Addition <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. PEE[)!/051 RRIC I:ON <br /> E-All Other 1365 Ei <br /> — —i <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NC. <br /> ❑ YES ® NO 0 YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEE <br /> 210 <br /> Sq.Ft. Sq.Ft.210 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $4,200.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE$131.50 <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 tli 11 {all..re , <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and sibj )ct <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 SI NATU'' ner/Agent l J1k 1 E: <br /> Ordinances.Any unauthorized change from the information or I_ I, <br /> �� Z%' � <br /> plans submitted will invalidate the permit. 1 `� i /i [o �`5 <br /> OFFICE USE ONLY . .._.,.. -,,. <br /> (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/06/2015 S C W 1 <br /> ❑ //f�/�® NO DATE REVIF1l� <br /> WED INITIALS �� 2nd INSPECTION DATE INITIALS <br /> Initials <br />