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DANE COUNTY ZONING PERMIT DCPZP-2015-00439 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT S SCIDMORE (608)833-1155 Hart DeNoble Builders Inc (608)831-4422 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3614 ICE AGE DR 7923 Airport Road <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53719 Middleton,WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jfranzen @denoblebuilders.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-014-8001-5 TOWN OF ROXBURY 1 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 7840 PADLEY RD <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 Ex Exclusive Ag 120 Description:sfr w/coy frt por 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2015-00162 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES I: NO ❑ YES ❑ NO EC-2015-0219 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 32 Sq.Ft.2438 Sq.Ft.3088 <br /> 5526 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $950,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $464.45 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 SIG• •TURE: • ner ± •ea�� DATE: <br /> Ordinances.submitted Any will invalidate the from the Information or ` �— (1—� <br /> plans submitted will invalidate the permit. `�Q <br /> OFFICE L'SE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS ] y�SPE T ATE I ..ALS <br /> 06/17/2015 RLB lF`{7//F���j==d <br /> • ❑ YES ® NO DATE REVIEWED INITIALS 2 C 10 ATE INI ALS <br /> Initials j t <br />