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DANE COUNTY ZONING PERMIT DCPZP 2015-0NO. Page 1 of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT DANIEL OLSON 1-(970) 252-1687 Harrison Construction (608) 345-4540 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2095 UPHOFF RD 1500 Bradford Bay <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 Waunakee, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mharrison @tds.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0711-143-8560-8 TOWN OF COTTAGE GROVE 14 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2095 UPHOFF RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-4 Rural Homes 21.15 Description:Second story,garage and pergola(s) 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> CI Other: Private <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 ❑ NO ® YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4440 <br /> Sq.Ft.0 Sq.Ft.2200 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $150,000.00 <br /> 2 Sq.Ft.2240 Sq.Ft. PERMIT FEE <br /> $383.00 <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 County SI NAT RE: Owner/Age•, DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. • �� . 1 - ' 77 - <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/19/2015 DJ E1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />