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DANE COUNTY ZONING PERMIT ZONING 2015-00 30 Pagp 1 of 2 <br /> ,:.ER INFOB,V;,TrCN ,.'2ENT CONTRACTOP I":iFCRM A TION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN C SAMZ (608)643-2606 SCB CONSTRUCTION (608)393-0500 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9461 BOLTON RD 823 20TH STREET <br /> (City,Stab,Zip) (City,State,ZIP) <br /> SAUK CITY,WI 53583 PRAIRIE DU SAC,WI 53578 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JCSAMZ13@MERR.COM BANDCBALLWEG©CHARTER.NET <br /> SECTION 1/4 1/41/4 <br /> 0907-183-9450-6 TOWN OF ROXBURY 18 SW SW <br /> HOUSE NO. ST.DIRECTION, NAME ST.TYPE <br /> (Assignment of new address Is 9461 'STREET BOLTON RD <br /> subject to flsld verification.) <br /> LOT BLOCK I C.S.M.N).or PLAT NAME , <br /> METES AND BOUNDS <br /> ZONING DISTRICT I�ARCEL ACREAGE I PROPOSED OJECT: Alteration to existing building CENSUS CODE <br /> R-1 Residence 1.86 Description:4ason porch addition 434-Residential Addition <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Aod utiurai I SEWER SANITARY PERMIT NO. <br /> ❑ Other Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO., VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2862 <br /> ❑ YES 0 NO <br /> SHOREIANO FLOOD ZONE WE IAND1 ECJSW NO. <br /> ❑ YES 0 NO ❑ YES 0 NO ❑ YE#S 0 NO <br /> HEIGHT(In Feet) BASEMENT I 1st FLOOR TOTAL SQUARE FEET <br /> 748 <br /> 12.5 Sq.Ft.374 Sq.FL 374 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $55,000.00 <br /> 1 Sig.R. S4 Ft PERMIT FEE <br /> $106.10 <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 4oning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County 5IG T • : 1 �� • -� DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. . ./ /6 �� <br /> OF JE USE TN._, ,t^.rri•.ersiun 03 00 CT) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> A <br /> D. YES 0 NO 09115/2015 SJW3 <br /> F/}►' DATE RAAE.V)EYYED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: �\°%i j F� <br /> A <br />