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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2015-00821 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KEITH J MICKELSON (608) 445-9568 SELTZNER BUILDERS (608) 279-7088 <br /> BILLING ADDRESS(Number.Street) ADDRESS(Number,Street) <br /> 2935 HENSEN DR 7370 WILBURN ROAD <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 SUN PRAIRIE, WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-304-0245-7 TOWN OF BRISTOL 30 SE NE <br /> PROPERTY ADDRESS HOUSE NO ST DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address is 2935 HENSEN DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 45 SCOTTISH HIGHLANDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT New Structure/Addition CENSUS CODE <br /> A-1 Agriculture .9 Description.28'X 30 GARAGE 438 - Garage <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-All Other <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 840 <br /> 14 Sq.Ft. Sq Ft.840 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $40,000.00 <br /> 1 Sq.Ft Sq Ft PERMIT FEE <br /> $113.00 <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 SIGNATURE. Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or / • �. <br /> plans submitted will invalidate the permit. �� %0 4A5 <br /> • <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/09/2015 PMK2 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials I 5- <br />