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DANE COUNTY ZONING 'E RM IT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2015-00908 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> AHREN ROGERS ADAMS DESIGN CONSTRUCTION (608) 438-5560 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 205 MEMPHIS AVE PO BOX 7727 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53714 MADISON, WI 53707 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KEN @ADAMSOFMADISON.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-051-4805-3 TOWN OF BLOOMING GROVE 5 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 205 MEMPHIS AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M. O.or PLAT NAME <br /> 375 GALLAGHER, CLYDE A PLAT OF PT W 1/2 NE 1/4 5-7-10 (LTS 347-382) <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3 Residence 0.298 Description:second floor addition+second floor dormer 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED RESTRICTION <br /> D her 768 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 186 <br /> 20 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $75,000.00 <br /> 2 Sq.Ft. 186 Sq.Ft. PERMIT FEE <br /> $63.95 <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 com lying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. W tlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may re ult in removal or modification of construction that violates <br /> the law or other penalties or costs. For mor inform : -, •' the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the epartment • at al Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by D- e County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordin 'es. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA • - : 'i ner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. (. ���.- — CC ID No tJ�o/S <br /> OFFICE U.5t ONLY (form version 03.00.07) <br /> SURVEY REQUI- D? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/10/2015 SJ W 3 <br /> /I/ YES ® NO DATE REVIEWED INITIALS' 2nd INSPECTION DATE INITIALS <br /> \Initials: 4 �� It 1 5 <�T ' <br />