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DANE COUNTY ZONING PERMIT DCPZP 2015-00954 Page l of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DAVID K MAY (608) 849-6684 SCOTT MOREN (608)423-4241 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> Property owner has requested confidentia 1200 SPAHN DR 662 US HIGHWAY 12 & 18 <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 CAMBRIDGE, WI 53523 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> cmaytricorinsurance.com scoff @theloghomeguy.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0807-223-8180-0 TOWN OF BERRY <br /> 22 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5403 OTTO KERL RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 11031 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes 32.29 Description:single family residence 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other: <br /> Private 13-2015-00362 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 8365 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ec2015-0001 <br /> YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 9418 <br /> 31 Sq.Ft.2982 Sq.Ft.5276 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $950,000.00 <br /> 2 Sq.Ft. 1160 Sq.Ft. PERMIT FEE <br /> $756.35 <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 z • ins ectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT — 0 •ent DATE: <br /> Ordinances.Any unauthorized change from the information or A / <br /> plans submitted will invalidate the permit. •Iry / ' Z <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 9 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/07/2015 SSA1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />