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DANE COUNTY ZONING PERMIT DCPZP 2015-00484 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN B EVERITT (608) 837-0332 JOHN THOMPSON (608) 838-3140 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number.Street) <br /> 6919 BRIAR LN 5830 LEXINGTON ST <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 MCFARLAND, WI 53558 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> n/a john @thompsoncustombuilders.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-193-8230-3 TOWN OF BRISTOL 19 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME •ST.TYPE <br /> (Assignment of new address is 6919 BRIAR LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 10 Description.house addition 434- Residential Addition <br /> District <br /> Category 10 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO DEED RESTRICTION <br /> C-Town Road <br /> i] YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> ❑ YES ® NO (] YES 0 NO ❑ YES '® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5382 <br /> 34'-6" Sq.Ft. 1789 Sq.Ft.2403 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $951,000.00 <br /> 2 Sq Ft. 1190 Sq Ft PERMIT FEE <br /> $453.65 <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 Da .- County zoning inspectors for the <br /> purposes of determining compliance with the zoning • •ina . <br /> Owner&Agent hereby agree to comply with all Dane County S . to•Eze4„. ner/Agent 77/001/5°n�CsT'« DATE:, / <br /> Ordinances.Any unauthorized change from the information or ��f / �/ C <br /> plans submitted will invalidate the permit. 1_ i�// r 4;.w'�`-+� /�C� J <br /> OFFICE.USE ONL.g (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ES ® NO 07/01/2015 SSA1 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> InitialP," <br />