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I <br /> DANE COUNTY ZONING 'PERMIT ZONING Page 1of2 <br /> 00605 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN R SNELL (608) 835-5209 ADD ON REMODELING (608) 846-3598 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 558 ECHO VALLEY RD 429 LINDE ST <br /> i <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 DEFOREST, WI 53532 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> STELLREV @MAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-272-2619-3 TOWN 0 OREGON 27 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 558 ECHO VALLEY <br /> subject to field verification.) RD <br /> LOT BLOCK C.S.M. O.or PLAT NAME <br /> 19 I 1 OREGON ASSESSOR'S PLAT,TOWN OF <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-1 Rural Homes 3.058 Description:l3x20 home addn 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial D Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 6123 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES a NO ❑ 'ES isi NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 8 60 <br /> Sq.Ft. Sq.Ft.60 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $10,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $54.50 <br /> I, the undersigned, am the owner of the prop rty or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be pe ormed, 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 t is 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. We lands that are not associated with open water can be <br /> difficult to identify. Failure to comply may re ult in removal or modification of construction that violates <br /> the law or other penalties or costs. For more nformation, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the D partment 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 SIGNATURE: • ner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or,„...)..., // / // �r '�� <br /> plans submitted will invalidate the permit. �` <br /> OFFICE USE.ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/07/2015 SJ W 3 <br /> 0 YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: �/ f' R •' 10-- 1-5 P y <br /> i/J <br />