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DANE OUNTY ZONING PERMIT DCPZP-2015-00555 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RANDY L E C ELBERGER (608) 835-2076 <br /> BILLING ADDRE- umber,Street) ADDRESS(Number,Street) <br /> 4782 COUN HIGHWAY A <br /> (City,State,Zip) • (City,State,Zip) <br /> OREGON, .3575 <br /> E-MAIL ADDRES' E-MAIL ADDRESS <br /> kaerle @cha - .net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509 S1-8310-0 TOWN OF OREGON 24 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of :w address is 4782 COUNTY HIGHWAY A <br /> subject to field v•ri cation.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRI• PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural •mes 4.06 Description:detached accessory building no sanitary fixtures 438- Garage <br /> Distri•t <br /> Category 'I Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> II Other: <br /> Private No fixtures allowed <br /> ROAD CLASSIFI••TON REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County ig way 6123 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES n NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1944 <br /> 3 Sq.Ft. Sq.Ft. 1944 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $9,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $195.80 <br /> I, the and 'gned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the prope I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on t e submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply i h any provision or condition of this permit renders this zoning permit null and void and <br /> subject to forcement action. <br /> I acknowl-• •e that I am responsible for complying with State and Federal laws concerning construction <br /> near or on -tlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to • ,ntify. Failure to comply may result in removal or modification of construction that violates <br /> the law or •t er penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at .dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby c• -ent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes • setermining compliance with the zoning ordinances. <br /> Owner&Agen eby agree to comply with all Dane County SI ATURE: Owner/Agent s ATE: <br /> Ordinances.A , nauthorized change from the information or <br /> plans subm' = ill invalidate the permit. i,7- a 1 • 5 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUI' I ? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/21/2015 SC W 1 <br /> ❑ S ® NO DATE REVIEWED �-^ INITIALS f/I 2nd INSPECTION DATE INITIALS <br /> a Initial s, 1 (� \ Q <br />