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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2015-00151 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LOEDER REV TR,DANIEL&KRISTIA Farwell Pools (608)222-1730 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4410 BUCKLEY RIDGE CIR 3818 County Road AB <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 Madison, WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> duane @farwellpools.com <br /> PARCEL NO. TOWNSHIP SECTION 114 1/4 1'4 <br /> 0711-101-4089-0 TOWN OF COTTAGE GROVE 10 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4410 BUCKLEY RIDGE CIR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 9 BUCKLEY RIDGE <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1A Residence Description:in ground pool 329 - Other <br /> District <br /> Category 0 Residential 0 Commercial El Agricultural SEWER SAW WRf PERM!I NO <br /> Other:inground pool Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED REST RIC T ION <br /> E-AII Other <br /> YES NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> D YES ® NO fl YES ® NO El YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 648 <br /> Sq.Ft. Sq.Ft.648 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 <br /> 0 sq.Ft. Sq.Ft. PERMIT FEE <br /> S98.60 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the o\vner 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 SIG ATU Owner/Agent D TE: <br /> Ordinances.Any unauthorized change from the information or 4 / <br /> plans submitted will invalidate the permit. '411 ' ' 1,' <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/06/2015 SCW1 1 <br /> i ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initi g,� <br />