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DANE COUNTY ZONING PERMIT DCPZP-2016-00054 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KENNETH KARLS (608) 279-9164 GARY M KARLS (608) 798-3774 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 10795 N PERRY RD P.O. BOX 12 <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> krkarls @live.com qualitywestinc @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0506-052-8590-0 TOWN OF PERRY 5 NW NW <br /> PROPERTY ADDRESS HOUSE NO. 'ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10801 N PERRY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14123 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.0 Description: ,- Q 101 - SFR (detached) <br /> District 4j fl' , a� D,Gv ji <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: <br /> Private 13201600011 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10886 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6668 <br /> 24 Sq.Ft.2587 Sq.Ft.4081 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $322,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $550.10 <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 SIGNATU- - e f er/Ag 0- DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. S/ 01 /`� 3 -Z/G' <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED ,IIALS 1st INSPECTION DATE INITIALS <br /> 03/02/2016 SSA1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: bi"1/Z..— \ ^ 9. – / G r ri K <br />