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DANE COUNTY ZONING ' ERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPZP-2015-00622 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHAEL A KRIEFSKI (608) 835- 406 GARY WIMMER (608)444-0584 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 633 N WOODS EDGE 5113 VERONA RD <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 MADISON, WI 53711 <br /> E-MAIL ADDRESS ittlilimaralk I E-MAIL ADDRESS <br /> ••- ;- • h -united.com gwimmer @brmkit.com <br /> .. . <br /> PARCEL NO. TOW■IS HIP SECTION 1/4 1/41/4 <br /> 0509-064-8085-0 TOWN O' OREGON 6 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTIO STREET NAME ST.TYPE <br /> (Assignment of new address is 6128 SUN VALLEY PKWY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M. O.or PLAT NAME <br /> 1 CSM 11894 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSE.PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 15.5 Description: nground pool 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Aericultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.N.. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 9321 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLA D EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ ES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 800 <br /> Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $110.00 <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 pe ormed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply wi h the applicable zoning ordinances. I understand that failure. <br /> to comply with any provision or condition of his permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for co plying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wrtlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may rz.,ult in removal or modification of construction that violates <br /> the law or other penalties or costs. For morz 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 consent to the entry on the permitt=d 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 SIGN' 4 RE: Owner/ ent DATE: <br /> Ordinances.Any unauthorized change from the information or �'-'�„ c7 r <br /> plans submitted will invalidate the permit. I 1 _ (/fn.4A-�i' 0 1 Z-_"I S <br /> ■OFF ICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/12/2015 SSA1 <br /> YES ® NO DATE REVIEWED �� INITIALS I �� 'nd INSPECTION DATE INITIALS <br /> Initials: (� 1 ,/' Vim, 4 <br /> c� <br />