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DANE COUNTY ZONING PERMIT DCPZP-201h6-00010 Page 1 of 2 <br /> OWNER INFORMATION AGENT CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAMES R KOSTINEK (608)884-9688 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 482 WINDWOOD CIR <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON,WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JKOSTINEK@YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0512-272-0210-3 TOWN OF ALBION 27 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 482 WINDWOOD CIR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 20 WINDWOOD HEIGHTS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 0.86 Description:14x20 lofted garage <br /> 329-Other <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> [I] otner: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 1601 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 11'10" 280 <br /> Sq.Ft. Sq.Ft 280 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $7,800.00 <br /> 1 Sq.Ft. Sq.Ft PERMIT FEE <br /> $71.00 <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 SI TURE: • •get //� DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted w0I invalidate the permit. <br /> / / d'/i/�/L_� //� /ICJ <br /> CFF'CE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> El YES ® NO 01/13/2016 SJW3 <br /> DATE REVEWED INITIALS 2nd INSPECTION DATE INITIALS <br />