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DANE COUNTY ZONING PERMIT Page 1of2 <br /> DCPZP 20 5 00919 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KEVIN L NORTH (608) 290-8761 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 71 US HIGHWAY 51 <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0512-341-9372-6 TOWN OF ALBION <br /> 34 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 741) US HIGHWAY 51 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 09261 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT. Alteration to existing building CENSUS CODE <br /> R-2 Residence 1.687 Description:deck&stoop addn 434 - Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> Private <br /> Other. <br /> ROAD CLASSIFICATION 'REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 7419 ❑ YES NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> D YES ® NO ❑ YES 0 NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 105 <br /> Sq Ft Sq.Ft. 105 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $150.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $57.88 <br /> I, the undersigned, am the owner of the pro •erty or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be pe ormed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply wi h the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of his permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for corn 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 more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the epartment 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/A nt D TE: <br /> Ordinances.Any unauthorized change from the information or I � <br /> plans submitted will invalidate the permit. �— - <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/12/2015 SC W 1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: ��/ <br />