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• Application Number: APP-32965 • ZONING PERMIT NO. DANE COUNTY ZONING PERMIT Page 1 of 2 ZP20090084 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE JEREMY VAN HORN (608)795-2888 SAME AS OWNER (608) 712-5877 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 8999 RANDOLPH CT (City,State,Zip) (City,State,Zip) AitocZ6 B6Ae+-EflRTH, WI 53560 E-MAI L-ADDRESS E-MAIL ADDRESS JVHORN @TDS.NET PARCEL NO. TOWNSHIP SECTION 1/a 1/4 1/4 0806-192-8670-5 BLACK EARTH 19 NW NW :I.]J I it CN.1'1.1:7 4*111111 HOUSE NO. ST.DI ECTION STREET NAME ST.TYPE (Assignment of new address is subject to field verification.) $' RANDOLF RD LOT BLOCK C.S.M.NO.or PLAT NAME 3 CERTIFIED SURVEY MAP: CSM 03651 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New I Addition/Alteration CENSUS CODE A 1 EX 6 Description:24'X36' HOUSE ADDITION 434 - RES ADD CATEGORY Residential Li Commercial ❑Agricultural SEWER SANITARY PERMIT NO. ❑Other 24'X36' HOUSE ADDITION ❑Public ]Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION C ❑Yes ❑No SHORELAND FLOOD ZONE WETLAND EC/SW NO ❑Yes No ❑Yes No ❑Yes No HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 20 864 864 2592 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 90,000.00 2 864 PERMIT FEE Sq.Ft. Sq.Ft. $ 244.00 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 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 & 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. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit OFFICE USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPE6O D4E a �yt�19� ❑Yes No 25 Mar 2009 pmk2 h/G/'"/ DATE REVIEWED INITIALS 2nd INSPECT NlD T: I I I Initials: 3 f ��° Conditions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRES NTED. ANY MODIFICATION TO THE PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VOID IF ANY MODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. INITIALS 2. EROSION CONTROL: OWNER/AGENT MUST CONTACT THE DANE COUNTY DEPARTMENT OF LAND&WATER RESOURCES(608-224-3647)TO HAVE IT DETERMINED IF AN EROSION CONTROL PERMIT IS REQUIRED. SIGNATURE DATE 545-112(12/05) GCS-multi