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DANE COUNTY ZONING PERMIT DCPZP-2015-00563 Page 1 of 2 <br /> OWNER INFORMATION ; AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STEWART J & CINDY BALLWEG (608) 393-8550 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6494 COUNTY HIGHWAY KP 9494 DONNETTE DR <br /> (City,State,Zip) (City,State,Zip) <br /> SAUK CITY, WI 53583-9727 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> scballweg @merr.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0907-294-9930-0 TOWN OF ROXBURY <br /> 29 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6671 HERBRAND RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 2 CSM 13580 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Stru'r�e/Addition CENSUS CODE <br /> R-1 Residence 1.116 Description: ( �, / 438 -Garage <br /> District _y 4r bi-t <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13-2014-00409 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10495 ❑ 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 /> 1344 <br /> 14'-2" Sq.Ft. Sq.Ft. 1344 - <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $45,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $150.80 <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 SIGN TURE:1.wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or • I (� <br /> Hans submitted will invalidate the permit. A •j- RAI _ Je ll. X t_ <br /> OFFICE USE ONLY (form version 03.00.07) <br /> ■ <br /> RVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/23/2015 SSA1 <br /> ❑ YES I21 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> 09-6, <br />