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DANE COUNTY ZONING PERMIT DCPZP 2015 00406 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MARC J NORDSTROM (608) 516-9478 ACCENT HOMES AND CONSTRUCTION (608) 575-0208 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1716 CHAPIN LN 2364 JACKSON ST#205 <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JGRIF47 @YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0611-312-0067-0 TOWN OF PLEASANT SPRINGS 31 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3065 COURSE VIEW DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 7 COUNTRY CLUB ESTATES <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 0.474 Description:SFR+front,rear porch+rear deck 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-Ali Other 9198 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ❑ NO ❑ YES lil NO ❑ YES ® NO <br /> SE2015-0163 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 26 Sq.Ft. 1918 Sq.Ft.2857 <br /> 5171 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $330,000.00 <br /> 2 Sq.Ft.396 Sq.Ft. PERMIT FEE <br /> $437.83 <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 St' ATURE: Ow•er/ -'t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / 6�/© -f S <br /> . vaas- <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED / INITIALS 1st INSPECTION DATE INITIALS <br /> ® 06/10/2015 SJW3 <br /> /ES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: ,- 44 <br /> II <br />