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DANE COUNTY ZONING PERMIT DCPZP-2015-00946 Page 1 of 2 OWNER INFORMATION i AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE LUBCKE LIVING TR,TERRY J&JANICE L (608) 835-7006 WOOD CONSTRUCTION, INC. (608) 220-1390 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 4718 EISENHOWER ST 4000 OLD STONE ROAD (City,State,Zip) (City,State,Zip) OREGON, WI 53575 OREGON, WI 53575 E-MAIL ADDRESS E-MAIL ADDRESS TIMWOODCONSTRUCTION @YAHOO.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0510-182-2762-5 TOWN OF RUTLAND 18 NW NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 4718 EISENHOWER ST subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 32 FAHEY HEIGHTS-1ST ADDITION ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE R-1 Residence .5 Description:18'X 20'FAMILY ROOM ADDITION 434- Residential Addition District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Private VARIANCE ❑ Other: ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED RESTRICTION E-All Other 1568 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 360 13.5 Sq.Ft. Sq.Ft.360 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $65,000.00 1 Sq.Ft. Sq Ft PERMIT FEE $77.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIG ,I �''. :��r. !en / DATE: Ordinances.Any unauthorized change from the information or r/ / _ plans submitted will invalidate the permit. ili / ieff 11! ,-/5 OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 12/01/2015 PMK2 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials:1 (77W....)