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DANE COUNTY ZONING PERMIT DCPZP-2015-00982 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ANNE L APLIN Austin Gannon (608) 838-4161 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4355 KRUEGER RD 4719 Farwell St. <br /> (City,State,Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 Mcfarland, WI 53558 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> austingannon @yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-112-9270-0 TOWN OF DEERFIELD 11 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME • ST.TYPE <br /> (Assignment of new address is 4370 Krueger RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 14140 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE <br /> R-1A Residence 2 Description:sfr w/screen&covered porch 101 - SFR (detached) <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13201500396 <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10803 ❑ 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 /> 4449 <br /> 14 Sq.Ft. 1541 Sq.Ft.2908 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $270,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $383.68 <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 NATU- : 0 . 'gent ,'ATE: <br /> Ordinances.Any unauthorized change from the information or /1 <br /> plans submitted will invalidate the permit. ' �z <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/22/2015 SC W 1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initia <br /> /1111� <br />