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DANE COUNTY ZONING PERMIT DCPZP2015-00918 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANIEL P SEARS SR (G0.8)0)61...//390 Ed Hefty Construction ((608)212-0420 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> G2. 1 G 7'11 n ms 0 n L A n e 1036 Hillcrest Lane <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 Oregon, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> vacationed @aol.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0510-081-9100-0 TOWN OF RUTLAND 8 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4361 US Highway 138 HWY <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 1 CSM 11985 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CE SUS CODE <br /> RH-3 Rural Homes f lDescriPbon1SFR (detached) <br /> s F 0/Front* Recvc PO e.5 <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13-2014-00353 <br /> ROAD CLASSIFICATION 'REZON ' . q (0 C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. / <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO EC 0 O/ /- 0.3 6 1/ cP1.4)0).c—Q o I <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR / `l TOT FEET/ V <br /> 5511 <br /> 20 Sq.Ft.2152 Sq.Ft.3359 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $365,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $463.33 <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 A - il _"� /'--/� <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/12/2015 RWL1 <br /> ❑ YES ® NO DATE REVIEWED INITIA 2nd INSPECTION DATE INITIALS <br /> Initials: ,l,. la - ).- P <br />