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DANE COUNTY ZONING PERMIT DCPZPZONING PER 2015-00603 MIT NO. Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ANDREW W BURT (608) 445-4096 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7633 TIGER LILY CT <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> andrewburt©hotmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-203-2179-0 TOWN OF MIDDLETON 20 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7633 TIGER LILY CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 59 SPRUCE HOLLOW <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT. New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 0.76 Description:deck addition to house 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION <br /> E-AII Other <br /> ❑ YES 0 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 /> 462 <br /> Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $8,000.00 <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $84.65 <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 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 <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 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 Ow - nt % DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. !-' ' <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st IN :Er TIO D• INITIALS <br /> 08/07/2015 SSA1 - <br /> ❑ YES ® NO DATE REVIEWED / INITIALS 2nd IN ' TI'N P• INITIALS <br /> Initials I; " <br />