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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP 2016-00148 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> Jeff Ball (608) 213-9068 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> W8976 County Road C <br /> (City,State,Zip) (City,State,Zip) <br /> Fort Atkinson, WI 53538 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeffba1161@gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-244-9002-0 TOWN OF DEERFIELD 24 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 84 Fair Oak <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: Alteration to existing building CENSUS CODE <br /> A-1 Ex Exclusive Ag 37 Description:front entry and rear deck addn 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private na <br /> ❑ <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <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 /> 520 <br /> 11 Sq.Ft. Sq.Ft.520 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $15,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $89.00 <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 SIGN' • - %' at • 'gent DATE: <br /> Ordinances.Any unauthorized change from the information or r/' 4 <br /> plans submitted will invalidate the permit. / ` 7-/G <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/07/2016 SCW1 <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />