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DANE COUNTY ZONING PERMIT DCPNGPERM-00517 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME <br /> CORY R JOHNSON (608) 669-2803 KNL TRINITY HOMES PHONE <br /> (242) 939-3808 <br /> BILLING ADDRESS(Number,Street) <br /> ADDRESS(Number,Street) <br /> 1850 PENNSYLVANIA AVE <br /> 6803 152ND AVENUE <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 KENOSHA, WI 53142 <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> SUE @TRINITYHOMEBUILDERSWI.COM <br /> PARCEL NO. TOWNSHIP SECTION <br /> 1/4 1/4 1/4 <br /> 0911-191-2111-0 TOWN OF BRISTOL 19 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME <br /> ST.TYPE <br /> (Assignment of new address is 3124 WYNDWOOD <br /> subject to field verification.) WAY <br /> LOT 'BLOCK I C.S.M.NO.or PLAT NAME <br /> 31 NORWAY ROAD ESTATES <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition <br /> A-1 Agriculture .75 Description:SFR CENSUS CODE <br /> District 101 -SFR (detached) <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2016-00212 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. <br /> E-All Other DEED RESTRICTION <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> 0 YES @ NO ❑ YES ® NO ❑ YES ® NO <br /> - <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR <br /> TOTAL SQUARE FEET <br /> 14.5 Sq.Ft. 1662 Sq.Ft.2368 4030 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $225,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $352.25 <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 IGNAT!RE: Ow er/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or Ill l <br /> plans submitted will invalidate the permit. Imp I <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> r4 08/12/2016 HJH3 <br /> Y S ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />