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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2015-00142 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN A PLAMBECK (608)233-0782 THE HOUSE DOCTORS M.D.,INC. (608) 745-8560 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2968 WAUBESA AVE W8024 MORSE RD <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53711 POYNETTE, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TJOHNSON @HOUSEDOCTORSMD.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 114 1 4 <br /> 0610-054-2333-7 TOWN OF DUNN <br /> 5 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 2968 WAUBESA AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 13 2 WAUBESA BEACH- <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3 Residence .28 Description:SFR ADDN AND REMOVAL OF EXISTING 434 - Residenti: i Addition <br /> District IMPERVIOUS SURFACE <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SAN II ,, i'}i: <br /> ❑ Other: <br /> Public <br /> _I <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRIC?ION ' <br /> E-All Other <br /> YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. ~ <br /> 0 YES ❑ NO ii YES ® NO ❑ YES 0 NO 2015-00062 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 232 <br /> 10 Sq.Ft. Sq.Ft.232 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $130,000.00 <br /> 1 Sq.Ft. Sc.Ft. I'LRIt1 F.-- -- ----I'. <br /> .i.)67 <'() <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf Of the u A'n : <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 th <br /> purposes of determining compliance with the zoning ordi -•`s. <br /> Owner&Agent hereby agree to comply with all Dane County SI e • • • ' /0 . ent DATE: <br /> Ordinances.Any unauthorized change from the information or - gent if--('.-/S <br /> plans submitted will invalidate the permit. <br /> OFFICE V'sE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/01/2015 H J H 3 <br /> 'ES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials <br />