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DANE COUNTY ZONING PERMIT DCPZP 2015-00200 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ANDREW R LOVICK (608) 695-0643 RANDY SHOWERS St Rwtd (f20% (3-1 CO( 39 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4319 HAWK TRL c115 f tor-le . PkAA,1 <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 � �fQ`�� , W\ tj 3 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SS‘nlx- lOtk-r CKSSCCc • Mai I- Lt7YV1 <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0910-112-9000-8 TOWN OF WINDSOR 11 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7590 KINDSCHI RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 40 Description:teardown and rebuilt of single family residence 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ <br /> Other: Private 13-2015-00092 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES IA NO ® YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5422 <br /> 29 Sq.Ft. 1858 Sq.Ft.2788 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $368,000.00 <br /> 2 Sq.Ft.776 PERMIT FEE <br /> sq.Ft. $456.65 <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 Coun IGNA I RE: 0 , - - s ent DATE: <br /> Ordinances.Any unauthorized change from the informa'• or / _ <br /> plans submitted will invalidate the permit. - G 'L �L <br /> OFFICE USE ONLY (form version 03 00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> • YES ® NO 04/22/2015 SSA1 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initia • CA t i y <br />