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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RYAN P HAACK (608) 234-8400 CHRIS MILLER CONSTRUCTION LLC (608) 206-1106 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1385 HOLZHUETER RD 3186 KINNEY RD <br /> (City,State,Zip) (City,State,Zip) <br /> DEERFIELD, WI 53531 COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0712-203-8190-1 TOWN OF DEERFIELD 20 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3766 OAK PARK RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 03135 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RH-1 Rural Homes 2.26 Description:2 DECKS TO EXISTING SFR 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 4681 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ❑ NO ❑ YES ) NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 212 <br /> 6 Sq.Ft. Sq.Ft.212 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $2,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $65.90 <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 SI ' •TU- • Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. Au• q‘' ZT' / C <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/24/2016 HJ H 3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />