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DANE COUNTY ZONING PERMIT DCPZP-2016-00091 Page oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PATRICIA K KARLEN (715)579-2667 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> i3 y. (511 7,,Ae._( ,r <br /> (City,State,Zip) ' 4 k4- , 5 g (City,State,Zip) <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PAT.KARLEN @DOT.WI.GOV <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0511-212-9111-9 TOWN OF DUNKIRK <br /> 21 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 691 COUNTY HIGHWAY N <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 07484 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-2 Residence 1.29 Description:SFR 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Septic 13-2016-00036 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ❑ NO ❑ YES j NO ❑ YES ® NO SE-2016-0037 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 2592 <br /> 15 Sq.FL Sq.Ft.2592 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $180,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $244.40 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 SIGNATURE' wner!Agent DATE. <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. �< . ,3--17—)6 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/17/2016 HJH3 <br /> ❑ <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: /1i- "' <br />