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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ALLEN J GIERHART (608)214-3194 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) At <br /> 1481 COUNTY HIGHWAY W <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> gierharta @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0512-052-8835-0 TOWN OF ALBION 5 NW NW <br /> • <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1535 County Highway W <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14183 <br /> ZONING DISTRICT PARCEL ACREAGE <br /> PROPOSED PROJECT: .IJew Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.29 Description:sfr 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. L, <br /> ❑ Other: Private 13201600067 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 10888 ❑ YES ® NO ', <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES WI NO ❑ YES ® NO ❑ YES ® NO �� <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5630 <br /> 17.5 Sq.Ft.2053 Sq.Ft.3577 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $310,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $472.25 <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 SIG •TURE: Ow r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or I / /,, 7 /plans submitted will invalidate the permit. i 1 , <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/07/2016 SCW1 <br /> Initial, <br /> f YES l NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />