DCPZP-2009-00084 - Laserfiche WebLink

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Application Number:APP-32965 • DANE PERMIT NO. DANE COUNTY ZONING PERMIT Page 1 oft 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) BLACK EARTH,WI 53560 E-MAIL ADDRESS E-MAIL ADDRESS JVHORN @TDS.NET PARCEL NO. TOWNSHIP SECTION El 1/a t/4 0806-192-8670-5 BLACK EARTH 19 NW A PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME • _ U �� ST.TYPE- (Assignment of new address is subject 8999 RAN P LPH /• / to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 3 CERTIFIED SURVEY MAP: C: 03651 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New II Addition/Alteration CENSUS CODE A 1 EX 6 Descnption:24'X36' HOUSE ADDITION 434 - RES ADD CATEGORY Residential Cl Commercial ❑Agricultural SE SANITARY PERMIT NO. CI Other 24'X36' HOUSE ADDITION ■Public Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. ARIANCE NO. DEED RESTRICTION C ❑Yes Li No SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑Yes No ❑Yes No ❑Yes o HEIGHT(In Feet) BASEMENT 1 .FLOOR TOTAL SQUARE FEET 20 864 864 2592 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3ir FLOOR $ 90,000.00 2 864 PERMIT FEE Sq.Ft. Sq.Ft. $ 244.00 1. I,the undersigned,hereby make application for a zoning •-rmit 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 prop- ,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 un• rstand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply ith 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 appli . •ility of any official map to the applicants'land; • No such official map is applicable,or,if su map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of•ounty erhployees in giving these assurances; • I understand the possible adverse cons=•uences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit is •ed for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village • city shall be null and void. 3. I, the undersigned, hereby consen o the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compli nce with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating ith issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. Owner&Agent herebyag - to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any una • • ed change from the information or plans submitted will i alidate the permit OFFICE USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS Li �'� No 25 Mar 2009 pmk2 DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: Conditions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. 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