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DANE COUNTY ZONING PERMIT DCPZP-2015-00359 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KEITH A COMSTOCK (608) 877-1115 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 788 TAYLER LN <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CLARKHTG @SBCGLOBAL.N ET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-253-3131-8 TOWN OF DUNN 25 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3396 QUAM DR <br /> subject to field verification.) <br /> LOT 'BLOCK C.S.M.NO.or PLAT NAME <br /> 11 QUAM'S PARK,OLE J,ADDITION TO <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3 Residence .27 Description:REPLACE ROOF/TRUSSES ON SFR 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 813 ❑ YES p NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 0 <br /> 21.5 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $30,000.00 <br /> 2 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $50.00 <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 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 SIGNA ,U-E: 0 ner/A..-nt . > DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. = / ` . /-2`-`J <br /> OFFICE I;SE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/02/2015 HJH3 <br /> .❑ ++YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS ,_ <br /> nitials: C� fI2 y fii. - <br /> CJ . <br />