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DANE COUNTY ZONING PERMIT DCPZP-2016-00625 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT HOSTRAWSER (608) 213-1807 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1174 NIRA LN <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ROBHOSTRAWSER @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0512-054-5721-0 TOWN OF ALBION 5 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1212 ELDON WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 21 BLUE MEADOW ESTATES <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence .478 Description:SFR WITH DECK AND PORCH 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other: <br /> Private 13-2016-00281 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 8383 YES la NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4779 <br /> 19 Sq.Ft. 1705 Sq.Ft.3074 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $235,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $408.43 <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 SIGN RE: Ow. -r/Agent 'DAAT : <br /> Ordinances.Any unauthorized change from the information or L% < !< <br /> plans submitted will invalidate the permit. <br /> - <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/20/2016 PMK2 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 4- <br />