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• Ap•Iication Number:APP-35857 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090427 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SHANE WOLFRAM (608)834-5981 MILLER CUSTOM HOMES, INC. (608)837-6076 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 5206 PRESERVATION PL 715 W. MAIN ST. <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE,WI 53590 SUN PRAIRIE,WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-251-2167-0 BURKE 25 NE Nw <br /> a:•]J 4;I r'/_10]r]N*fib HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 5206 PRESERVATION PL <br /> LOT BLOCK C.S.M.NO.er PLAT NAME <br /> 47 PLAT: BURKE CONSERVANCY ESTATES <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New 14 Addition/Alteration CENSUS CODE <br /> A-1 .779 Description:BEDROOM BATHROOM ADDN 434 - RES ADD <br /> CATEGORY X Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other:BEDROOM BATHROOM ADDN ❑Public :14 Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E ❑Yes ❑No <br /> SHORELAND �y�f FLOOD ZONE ��yt{ WETLAND �I EC/SW NO. <br /> ❑Yes pl No ❑Yes X]1 No ❑Yes )4 No <br /> HEIGHT(In Feet) BASEMENT i t FLOOR TOTAL SQUARE FEET <br /> 250 490 <br /> 17 Sq.Ft. 240 Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 60,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. $ 87.00 <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information.I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s)of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any stucture within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner 8 Agent hereby agree to comply with all Dane Cowtte'v RE: Owner/Agent <br /> WI <br /> Ordinances.Any unauthorized change from the information (�1 tM"" 1-n- <br /> or plans submitted will invalidate the permit <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑Yes A No 20 Jul 2009 HJH3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE PROJECT <br /> Conditions: REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE,I VQIOJ ANY <br /> MODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONIN .' JA', <br /> 2. SURVEY ADVISORY NOTE: A LOCATION SURVEY MAY BE REQUIRED TO VERIFY THAT THE <br /> BUILDING IS CONSTRUCTED ACCORDING TO THE PLAN SUBMITTED WITH THIS APPLICATION. <br /> 545-112(12/05) GCS-sing) S Ghe / et& Ovr ✓ — <br /> P <br /> — , s- C°1fs' {r <br />