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DANE COUNTY ZONING PERMIT DCPZP-2015-00952 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS J BOBEK (608)220-1975 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3115 HAWKS HAVEN TRL <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-224-9500-6 TOWN OF BRISTOL 22 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6925 ELDER LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> C-2 Commercial 1.21 Description:ADDITION TO SUPPER CLUB,BANQUET FACILITY 329-Other <br /> District <br /> Category ❑ Residential 0 Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2015-00370 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10774 3660 ❑ YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 32 Sq.Ft. Sq.Ft.6101 <br /> 7631 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $150,000.00 <br /> 2 Sq.Ft.1530 Sq.Ft. PERMIT FEE <br /> $500.00 <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 GN URE: Owner/A n� gg ` TE: <br /> Ordinances.Any unauthorized change from the information or S�/� <br /> plans submitted will invalidate the permit. / 2 - 3-/ s--41/t�` ! � <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ® YES CI NO 12/03/2015 HJH3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />