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DANE COUNTY ZONING PERMIT DCPZGPERMI00163 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEFFREY J VEDVIG (608) 516-7295 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2001 WASHINGTON RD <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> VEDVIG @SBCGLOBAL.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-251-9830-0 TOWN OF PLEASANT SPRINGS 25 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2001 WASHINGTON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M. %JO.or PLAT NAME <br /> 1 CSM 05656 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1A Residence 1.61 Description:24x24 detached residential garage 438-Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ ASricultural SEWER SANITARY PERMIT NO. <br /> Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 4270 ❑ YES O NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 576 <br /> 11 Sq.Ft. Sq.Ft.576 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $16,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $93.20 <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 wi`.h 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 SIGNAT . - ' :! n of , DATE: <br /> Ordinances.Any unauthorized change from the information or 4-124l1 <br /> plans submitted will invalidate the permit. /AU <br /> OFFICE USE JNLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INIT LS 1st INSPECTION DATE INITIALS <br /> 04/12/2016 SJ W 3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 4.1 <br />