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DANE COUNTY ZONING PERMIT DCPZP 2016 00296 Page oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> • <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHELLE CLASEN 212-2276 Rasmussen Builders 444-6382 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7955 ALMORE DR 7002 Park Cir. <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 Middleton, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0808-312-2189-0 TOWN OF SPRINGFIELD 31 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3024 Spring Blossom CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 29 AUTUMN POND <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1A Residence 1.5 Description:single family residence 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES 0 NO YES ® NO ❑ YES ® NO se2016-0161 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6365 <br /> Sq.Ft.2195 Sq.Ft.3288 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $450,000.00 <br /> 2 Sq.Ft.882 Sq.Ft. PERMIT FEE <br /> $527.38 <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 G401 RE: Own ent D'T E: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ,ld.e.. ` .i • ,. <br /> OFFICE USE UNLY (form veis:on 03.0'..00) <br /> SURVEY REQUIRED? DATE ISSUED INITI A 1st INSPECTION DATE INITIALS <br /> 05/26/2016 DJ E1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />