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ZONING PERMIT NO Page 1 of 2 <br /> DANE COUNTY ZONING PERMIT DCPZP-2015-00308 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DEAN T BREUNIG (608)963-5315 <br /> BILUNG ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9170 COUNTY HIGHWAY Y <br /> (City,State,Zip) (City,State,Zip) <br /> SAUK CITY,WI'53583 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-173-9710-0 TOWN OF ROXBURY 17 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 9170 COUNTY HIGHWAY Y <br /> subject to field verification.) <br /> LOT !BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13960 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New StructurelAddition CENSUS CODE <br /> RH-3 Rural Homes 9.1 Description:SFR 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2015-00093 <br /> ❑ Other. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 10806 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> Bj YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT '1st FLOOR TOTAL SQUARE FEET <br /> 6196 <br /> 30 sq.Ft.2315 Sq.Ft.3881 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $400,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $514.70 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 NATURE: • er/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or �� <br /> plans submitted will invalidate the permit. 'R\ Iota -. *"I <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSP-....ION DATE INITIALS <br /> 05/19/2015 HJH3 <br /> YES ❑ NO DATE REVIEWED , �j�► 2nd INSPECTION DATE INITIALS <br /> Initials: 5 a-a- ` p"" <br />