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. Application Number:APP-38506 - ZONING PERMIT NO. DANE COUNTY ZONING PERMIT Page 1 of 2 ZP2009RM OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE NATHAN BERGE (920)650-0263 KASSONDRA FARNSWORTH (920)397-0105 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 2709 CLEARVIEW RD W7896 SCHEPPERT ROAD (City,State,Zip) (City,State,Zip) CAMBRIDGE,WI 53523 FORT ATKINSON,WI 53538 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0712-333-8185-0 DEERFIELD 33 SW NE ;(.1 J 4:7[14E101 il;I 111111 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is subject 983 NULAND RD to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 1 CERTIFIED SURVEY MAP: CSM 12711 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: N New ❑Addition/Alteration CENSUS CODE A-2(2) 2.346 Description:SFRWlTH PORCHES 101 - SFR CATEGORY SEWER SANITARY PERMIT NO. Residential ❑Commercial ❑Agricultural 520411 ❑other SFR WITH PORCHES Li Public Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C 10018 ❑Yes ❑No SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑Yes No ❑Yes No LI Yes No EC20090266 HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 5053 • 23 1697 3356 Sq.Ft. Sq.Ft. PROJECT COST 160,000.00 NO OF STORIES 2nd FLOOR 3rd FLOOR PERMIT FEE 1 Sq.Ft. Sq.Ft. 429.00 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that information.I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the owner(s)of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. 2. I,the undersigned,hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information ,. _/ /� } or plans submitted will invalidate the permit. /I, L l�,_ I,AV: _. /,. /�q `7 e/ OFFICE LISE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DAT NIT"S X Yes Li No 13 Oct 2009 pmk2 1 / 1 1 DATE REVIEWED INITIALS 2nd INSPE T QN DATc/ INITI A Initials: k--- 4// / 1 o Conditions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VOID VOIWY MODIF TIONS A A IT OUT EXPRESS WRITTEN PROV L OF ANE COUN :TING.INITIALS 2. ER0, 25: 3 a , f. c s 0 Jo _-f55 1 l//3 05. OSION CtTROL. OWNER/AGENT MUST CONTACT TH DAN CO NTY DEPARTMENT OF LAND&WATER RESOURCES(608-224-3""7 TO HAVE IT .1 AIERMINED IQ'•N EROSION CQNTROL PERMIT IS REQUIRED. SIGNATURE /k ik tai 1) JL�.i. :4,,_4_ L -3 ATE 10- I `.. NIP 545-112(12/05) GCS-multi C e i.I k) 1CC/—5 S ,_ - .f /oil.3'(') I . A/C r i `'--f-- /OM)1/Y