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DANE COUNTY ZONING PERMIT DCPZP-2015-00892 Page 1of2 <br /> OWNER INFORMATION AGENTICONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PHILIP A SAUTEBIN (608)332-0206 Premier Builders Inc. (608)849-6770 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6516 HARVEST MOON CT 102 N Holiday Drive <br /> (City,Stale.Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 Waunakee,WI 53597 <br /> E-MAIL ADDRESS EMAIL ADDRESS <br /> sautebirp @hammescosports.com jeanette.acker @tds.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0909-363-2121-0 TOWN OF VIENNA 36 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 6516 HARVEST MOON CT <br /> subject to field verification. <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 23 NATURE VALLEY CONSERVATION NEIGHBORHOOD SUBDIVISION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> q- A-1-Ape Description: r��ln t i c 0� 434-Residential Addition <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> $FittYite <br /> ❑ Other: -F. 1..V C <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-Alt Other 8676 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES la NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 288 <br /> 14 Sq.Ft. Sq.Ft.288 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $20,000.00 <br /> 1 Sq.Ft. Sq Ft PERMIT FEE <br /> $71.60 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 SIGN Owner/Agent A DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will Invalidate the permit. 9,' / t1 ' ctiI*2 1/ a /i <br /> OFFICE USE(`i'ILY (form version 03.00.07) <br /> SURVEY REQU-ED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/02/2015 SC W 1 <br /> ❑ YE a NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> 5 <br /> Initi./� i l 1� s <br />