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DANE:COUNTY ZONING PERMIT Pagelof2 <br /> DCPZP 2015 00592 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RICHARD R.GORDON (608) 437 4959 QUALITY WEST CONSTRUCTION, INC. (608) 798-3774 <br /> BILLING ADDRE`.(Number,Street) ADDRESS(Number.Street) <br /> 3070 TOWN HALL RD P.O. BOX 12 <br /> (City.State,Zip) (City.State,Zip) <br /> MT HOREB, WI 53572 MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> qualitywestinc @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0607-153-9570-0 TOWN OF SPRINGDALE 5 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9081 EARLY AUTUMN RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S M.NO.or PLAT NAME <br /> CSM 11244 <br /> ZONING DISTRIG PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 20.755 Description 20'x 44'INGROUND POOL 329 - Other <br /> Districlt <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> Other Private <br /> ROAD CLASSIFIC'ITIDN 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 ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 880 <br /> Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO OF STORIES, 2nd FLOOR 3rd FLOOR $40,000.00 <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $116.00 <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 On`orcement 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 coisent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes o determining compliance with the zoning ordinances.Z �- <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner!Agen . bATE: <br /> Ordinances.Any unauthorized change from the information or „i _ - <br /> ,/,'.---plans submitted will invalidate the permit. Z--Zi t <br /> . <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/04/2015 PMK2 <br /> ❑ YES ® NO DATE REVIEWED ,INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: wt./ - <br />