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DANE COUNTY ZONING PERMIT DCPZP-2015-00411 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHAEL T VANDE VEN (920) 205-6812 Kelly Construction (608) 712-6599 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3618 PINE GROVE WAY 3026 Mounds View Rd <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53719 Blue Mounds, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> aherrling @gmail.com kellyconst @live.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0608-262-9551-0 TOWN OF VERONA 26 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2065 County Highway PB <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12360 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-1 Rural Homes 2 Description:sfr w/porch&decks 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13201500153 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 2573 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6574 <br /> 24 sq.Ft. 1513 Sq.Ft.3067 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $540,000.00 <br /> 2 Sq.Ft. 1994 Sq.Ft. PERMIT FEE <br /> $543.05 <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 j NATU""E: 0 rer/Ag- t DATE: <br /> Ordinances.Any unauthorized change from the information or A\ ,/f / / `� /��\plans submitted will invalidate the permit. ita . . ��✓ — 1/,L I. , <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/11/2015 SC W 1 <br /> ❑O YES ® NO DATE REVIEWED INITIALS ��,/// 2nd INSPECTION DATE INITIALS <br /> Initials +�'L//C— / I5 �/1 {0 <br />