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DANE COUNTY ZONING PERMIT ZONING DCPZP-2015-00891 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JENSEN REV LIVING TR,ROBERT&DIANNE (608)235-5456 THE BUILDER'S GROUP INC (608) 209-0074 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3376 QUAM DR 122 S OWEN DR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 MADISON, WI 53705 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DECCLES @THEBUILDERSGROUP.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-253-8856-0 TOWN OF DUNN 25 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1961 QUAM POINT <br /> subject to field verification.) RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14063 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .2 Description:SFR W/PERVIOUS DRIVEWAY 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER <br /> SANITARY PERMIT NO <br /> ❑ Other: Sewer <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv Streets 813 <br /> ❑ YES Qj NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ❑ NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 15.75 sq.Ft. 1680 sq.Ft.2336 4016 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $330,000.00 <br /> 1 Sq.Ft. Sq.Ft. <br /> PERMIT FEE <br /> $351.20 <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 SI - • - URE: • ner/•i _ t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ` I,LI If , to 30 <br /> OFFICE I ISE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/30/2015 HJH3 <br /> ® YES El NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> alas. 1 . --% <br />