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DANE COUNTY ZONING PERMIT DCPZP-201600283 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAY GOULD 16 O ) Cl i7 Tom Jones Company ((608)695-0828 <br /> BILLING ADDRESS(Number,Street) ,s ( ,rj L ir1 C 1 n ADDRESS(Number,Street) <br /> 807 WHISPERING OAKS RD (Z cP ., Onyx Court <br /> (City,State,Zip) .•11 (City,State,Zip) <br /> OREGON, WI 53575 VJL Oregon, WI 53575 <br /> E-MAIL ADDRESS - "-3•5 75 E-MAIL ADDRESS <br /> +13 or onescoryt•csn 1nc I. COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-072-8530-9 TOWN OF OREGON 7 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6271 Crestwood DR <br /> subject to field verification.) <br /> LOT C.S.M.NO.or PLAT NAME <br /> 3 1BLOCK I CSM 06989 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (4)Agriculture Description:Single Family Dwelling 101 -SFR (detached) <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ <br /> Other: Private 13-2016-00127 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 1 <br /> C-Town Road 1 ©O 9 C <br /> J ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 7071 <br /> 20 Sq.Ft.3196 Sq.Ft.3875 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $250,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $580.32 <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 SIGNATURE: Ow -r/,' nt DATE: <br /> Ordinances.Any unauthorized change from the information or -37213/1/2� <br /> plans submitted will invalidate the permit. /L` , ,�. 1/ <br /> P <br /> OFFICE USE`ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/23/2016 RW L1 <br /> ❑ YES ® NO DATE REVIEWED %/� INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: ~^ u /�^ / hvi\- <br />