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DANE COUNTY ZONING PERMIT DCPZP 2015-00287 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GERALDINE F JANOWSKI (608) 575-8282 TYLER JOHNSON <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 29200 JONES LOOP RD LOT 253 W8024 MORSE RD <br /> (City,State,Zip) (City,State,Zip) <br /> PUNTA GORDA, FL 33950 POYNETTE, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kmatzke @mac.com tjohnson @housedoctorsmd.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-054-2322-0 TOWN OF DUNN <br /> 5 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2970 WAUBESA AVE <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 12 2 WAUBESA BEACH- <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .25 Description:single family residence and screen porch 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv Streets ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES ® NO ❑ YES ® NO se2015-0121 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4940 <br /> 28 Sq.Ft. 1212 Sq.Ft.2180 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $640,000.00 <br /> 2 Sq.Ft. 1548 Sq.Ft. PERMIT FEE <br /> $420.50 <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 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 Co •ty zoning inspectors for the <br /> purposes of determining compliance with the zoning ordi ' .1. <br /> Owner&Agent hereby agree to comply with all Dane County SI i� �e = ' •ent DATE: <br /> v • <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> ,7- f/3"-(r. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/13/2015 SSA1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: er <br />