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DANE COUNTY ZONING PERMIT DCPZG PERMI 00757 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANIEL L NEWCOMER (608)635-7604 THE HOUSE DOCTORS M.D.,INC. (608) 635-7604 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 602 TENTH ST W8024 MORSE ROAD <br /> (City,State,Zip) (City,State,Zip) <br /> BRODHEAD, WI 53520 POYNETTE, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TJOHNSON @HOUSEDOCTORSMD.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-054-2388-2 TOWN OF DUNN <br /> 5 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2960 WAUBESA AVE <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 18 2 JI WAUBESA BEACH- <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .2 Description:SFR WITH PORCH AND DECKS 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv Streets <br /> O YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ® YES ❑ NO ❑ YES ® NO SE2015-0346 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5116 <br /> 25 Sq.Ft.1350 Sq.Ft.2250 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $370,000.00 <br /> 2 Sq.Ft. 1516 Sq.Ft. PERMIT FEE <br /> $433.70 <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 Dar- "ount, oning inspectors for the <br /> purposes of determining compliance with the zoning ordi r- c - Ai <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT Ifr ,:*P- 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? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ® YES ❑ NO 09/21/2015 PMK2 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: l f <br />