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,. <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. , =". `. .. . . .2 <br /> DCPZP-2015-00158 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KEITH B SEAMONSON (608) 873-5814 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1799 WILLIAMS DR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1:4 1,4 -- <br /> 0611-322-8330-0 TOWN OF PLEASANT SPRINGS 32 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address is 1799 WILLIAMS DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO or PLAT NAME <br /> 1 CSM 09931 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 1.38 Description:family room and master bedroom addition 434 - Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARYP_RMIi NC <br /> ❑ Other: <br /> Public <br /> — <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESrRICTIJN <br /> C-Town Road 7932 <br /> ❑ YES Ld NC <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> ❑ YES ® NO ❑ YES El NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 23'-6" 2571 <br /> Sq.Ft. 1083 Sq.Ft. 1083 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $392,036.00 <br /> 2 Sq.Ft.405 Sq.Ft. PERMIT FEE <br /> 5242.83 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the o,rmer of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructe(I 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 SIGN, 4 R . 1 e Agent DATE' <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. �� / 4)/i5 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑ YES ® NO 04/09/2015 SSA1 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: A.PO- <br />