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DANE COUNTY ZONING PERMIT DCPZP 2015-00300 Page 1 of 2 <br /> OWNER INFORMATION j AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STANLEY A REINKE (608) 249-2728 JAMES REINKE (608) 221-1380 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 417 MEMPHIS AVE 1303 BASKERVILLE AVE <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53714 MONONA, WI 53716 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> REINKEEAST72@ATT.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-051-2743-2 TOWN OF BLOOMING GROVE 5 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 417 MEMPHIS AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 6 GALLAGHER, ELISHA L PLAT-1ST ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3 Residence 0.248 Description:front yard handicapped access ramp 434- Residential Addition <br /> District <br /> Category ® Residential 0 Commercial 0 Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION <br /> E-All Other 768 D YES la NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES CO NO 0 YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 172.5 <br /> 4 Sq.Ft. Sq.Ft. 172.5 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $4,300.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $62.94 <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 orza' ances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA (RE: Owne.A. -nt ATE. <br /> Ordinances.Any unauthorized change from the information or / /r <br /> plans submitted will invalidate the permit. ",/1��:1 r L e Jt /8 lj <br /> OFF' E USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED _NITIALS 1st INSPECTION DATE INITIALS <br /> 05/18/2015 SJ W 3 <br /> %J//YY S ® NO DATE REVIEWED�(/� INITIALS �/�/�/J 2nd INSPECTION DATE INITIALS <br /> Initials: 1eX _,- _ZS/ •. ! V 'N/ V " I K <br />