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DANE COUNTY ZONING PERMIT DCPZGPERMI-00367 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SANDRA K HARTWIG DALE NORDBY (608)438-8699 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> W4845 26TH ST E 742 LONDON RD <br /> (City,State,Zip) (City,State,Zip) <br /> NECEDAH, WI 54646 DEERFIELD, WI 53531 <br /> E-MAIL ADDRESS QECENE D E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-273-8840-0 • OF DEERFIELD 27 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION pME STREET NAME ST.TYPE <br /> (Assignment of new address is 742 PL�NtNG&Ix.--- LONDON RD <br /> subject to field verification.) DANE.CO.it ' <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 /> A-1 Ex Exclusive Ag .23 Description:ADDITION TO EXISTING SFR(VARIANCE 3669) 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ii other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 3669 ❑ 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 /> 910 <br /> 13.75 Sq.Ft.591 Sq.Ft.318 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $30,000.00 <br /> 1 Sq.Ft. Sq.Ft. <br /> PERM! <br /> I, the undersigned, am the owner of the property or an authorized agent acting on beha of e 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 ■ww.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 TURF: Owner/Agent I TE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ® YES ❑ NO 06/03/2015 HJH3 <br /> NN jj DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> SW ° /v <br />