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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP-2016-00055 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SAMUEL J HAMILTON GARY M KARLS (608) 798-3774 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 606 BIRCHWOOD TRL 606 BIRCHWOOD TRL P.O. BOX 12 <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 MT HOREB, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> shamilton @vortexoplics.com qualitywestinc @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0706-143-9500-9 TOWN OF VERMONT 14 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4016 MOE RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br />(; ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.67 Description:single family residence and deck 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: <br /> Private 13201600023 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.N1. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10910 <br /> ® 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 /> 11196 <br /> 32 Sq.Ft.3902 Sq.Ft.5685 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $780,000.00 <br /> 2 Sq.Ft. 1609 Sq.Ft. PERMIT FEE <br /> $889.70 <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 com lying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. W tlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may re ult 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 w■ w.dnr.state.wi.us or contact the epartment 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 SIGNATUR •'Agent DATE: <br /> Ordinances.Any unauthorized change from the information or ii21P <br /> plans submitted will invalidate the permit. / ✓, 3_ 2 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/02/2016 SSA1 <br /> /❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: (9"14'1 Z i l l ( (j <br />