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z 2 �- CA-5 ( Ra. yii-lect . t Ap.licatlon Number:APP-32622 (.R MA ZONING PERMIT NO. DANE CO TY1 ING PER I rs ZP20090061 OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE HENRY BLANKE (608)212-2770 KEN ZIEGELBAUER (608)575-0745 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 1802 SAVANNAH WAY 500 REID DRIVE (City,State,Zip) (City,State,Zip) WAUNAKEE,WI 53597 MOUNT HOREB, WI 53572 E-MAIL ADDRESS E-MAIL ADDRESS BLANKE @CENTURYTEL.NET KRZ @CHARTER.NET PARCEL NO. TOWNSHIP SECTION y4 1/4 Y/4 0806-251-9001-0 BLACK EARTH 25 NE SW •J:T•l J4.0 1111.1:T=FF- HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE^ • (Assignment of new address is subject ' to field verification.) XXXX U S H I G H WAY 14 j i�1e ,2) E4.\ LOT BLOCK C.S.M.NO.or PLAT NAME A METES AND BOUNDS: METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: 21 New ❑Addition/Alteration CENSUS CODE RH-1 2.5 Description:SFR W/2 COV POR 101 - SFR CATEGORY A Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. ❑Other:SFR W/2 COV POR ❑Public g1 Private 518237 ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION A 7370 ❑Yes ❑No SHORELAND FLOOD ZONE �y WETLAND EC/SW NO. . ❑Yes )4 No CI Yes ,�No ❑Yes X No 20090023 HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 24 2432 4040 6472 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 497,200.00 PERMIT FEE 1 Sq.Ft. Sq.Ft. $ 535.00 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 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 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 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. 2. I,the undersigned,hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper 39 3- permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & q Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. NI Owner&Agent heieby agree to comply with all Dane County SIGN U RE: Own I: •-rat ' DATE: • �3 2 Ordinances.Any unauthorized change from the information ii r ,a or plans submitted will invalidate the permit a i` `r I �• OFFICE USE ONLY e SURVEY REQUIRED? DATE ISSUED INITIALS 1 FF SPECTION DATE INITIALS `� �� A Yes ❑No 12 Mar 2009 RLB DATE REVI D q INITIALS 2nd INSPECTION DATE INITIALS Initial .-42:1---- �/1\1��j \ �, 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE Conditions: PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VOID IF AN ODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. INITIAL�3��i 2. SURVEY REQUIREMENT: A LOCATION SURVEY IS REQUIRED TO VERIFY COMPLIANCE WITH ZONING ORDINANCE SETBACKS. THE SURVEY SHALL BE PREPARED BY A REGISTERED LAND SURVEYOR,AND MUST BE RECEIVED BY DANE COUNTY ZONING WHEN THE FOUNDATION/ o 545-112(12/05) GCS-single