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DANE COUNTY ZONING PERMIT ZONING ERMIT0542 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAMES ANDERBERG Chris Miller Construction,LLC (608) 877-1366 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 418 PARK VIEW RD 3186 Kinney Road <br /> (City,State,Zip) (City,State,Zip) <br /> DEERFIELD, WI 53531 Cottage Grove, WI 53 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kanderberg @qsemployment.com chris.miller.construction @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0712-324-9430-0 TOWN OF DEERFIELD 32 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1123 ROTH I E . RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14156 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE <br /> RH-1 Rural Homes Description:60'x 40'x 18'pers stor shed 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road dcprez-2015-10859 ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 9 NO ❑ YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 18 Sq.Ft. Sq.Ft.2400 <br /> 2400 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR #Error <br /> 1 sq.Ft. Sq.Ft. PERMIT FEE$230.00 <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 SIGNATUR : Owner/Agent _ DATE: <br /> Ordinances.Any unauthorized change from the information orx 2, 1 6 <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/22/2016 RLB <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />