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DANE COUNTY ZONING PERMIT DCPZP 2015-00978 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KALSCHEUR REV LIVING TR,DONALD W 8 JOAN I (608) 831-4869 JASON MONIGOLD (608) 214-3712 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5441 KALESEY CT LOT 5 10844 COUNTY HIGHWAY A <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MONTESILVER83 @YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0808-224-8190-3 TOWN OF SPRINGFIELD 22 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5441 KALESEY CT <br /> subject to field verification.) - <br /> I 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 /> R-4 Residence 5.4 Description:BEDROOM ADDN TO SFR W/6X6 LANDING 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 3834 544 <br /> 0 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 /> 246 <br /> 9.75 Sq.Ft. Sq.Ft.246 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $7,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $68.45 <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 SI NATURE: •wner/A'e t DATE: <br /> Ordinances.Any unauthorized change from the information oor � <br /> plans submitted will invalidate the permit. /2-2/4 <br /> OFFICE LSE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/21/2015 HJ H 3 <br /> .`y❑ YES ® NO DATE REVIEWED y_ INITIALS`_ c("` 2nd INSPECTION DATE INITIALS <br /> Initials: V r' \ 'Of 'jV ��1—�\ <br />