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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPZP-2015-00539 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN A RINIGSTAD (608)469-5350 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3749 OLD STONE RD <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> john.ringstad @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0510-,22,-9690-7 TOWN OF -UTLAND <br /> 22 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTIO STREET NAME ST.TYPE <br /> (Assignment of new address is 3749 OLD STONE RD <br /> subject to field verif cation.) <br /> LOT BLOCK C.S.M.N•.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED•ROJECT: Alteration to existing building CENSUS CODE <br /> A-1 Ex Exclu 3ive Ag 2/ Description:2:'x 26'x 3'oa opend deck addn to sfr 434 - Residential Addition <br /> District 1 <br /> Category ® Residential ❑ Commercial ❑ Agri ultural SEWER SANITARY PERMIT NO. <br /> Private <br /> fl Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION <br /> C-Town load ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES . NO ❑ Y S ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 400 <br /> 3 Sq.Ft. Sq.Ft.400 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $14,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $80.00 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the properly. 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&Agen.hereby agree to comply with all Dane County SIGNAT / / •..lit. -� - �.. DATE: <br /> Ordinances.Any unauthorized change from the information or / ��®�rl� <br /> plans submitted will invalidate the permit. / , I 7 /7 /5 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/17/2015 RLB <br /> ❑ YES ® NO DATE REVIEWED INITIALS /�' 2nd INSPECTION DATE INITIALS <br /> Initi • 7. f /5 1 t t K <br />