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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY ZONING PERMIT DCPZP-2015-00604 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> EMERSON MENDIETA (608)220-0316 ANA DASILVA <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3766 NORTH POINT RD <br />(City,State,Zip) (City,State,Zip) <br /> MIDDLETON,WI 53562-8380 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 21 SE SE <br /> 0708-214-7523-6 TOWN OF MIDDLETON <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br />(Assignment of new address is 3766 NORTH POINT RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 BRASSINGTON PLAT <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> A-1 Agriculture 0.364 Description:7x12 home addn 434 - Residential Addition <br /> District . <br /> SEWER SANITARY PERMIT NO. <br /> Category ® Residential ❑ Commercial ❑ Agricultural Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other ❑ YES IO NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 72 <br /> 13 Sq.Ft. Sq.Ft.72 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $14,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE$55.40 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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: Owner/Agent DATE: <br /> plasubmitted Ordinances.Any unauthorized the from the information'- G• cep ,` O /o 7 I/S. <br /> plans sub 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 /> 7� 0 YES ® NO DATE REVIEWED INITIALS 2nd IN CTION DATE INITIALS <br />/ Initials: f\--p e t c4\t) .0.-60,) <br />