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DANE COUNTY ZONING PERMIT DCPZP-2016-00640 Page oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SARA A KLINK (608)338-8944 Nolden Construction (608)513-4300 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 588 REMY RD 104 West Church Street <br /> (City,State,Zip) (City,State,Zip) <br /> BELLEVILLE, WI 53508 Belleville, WI 53508 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> saklink @sbcglobal.net noldenconstruction @yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0508-233-9831-0 TOWN OF MONTROSE 23 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 588 REMY RD <br /> subject to fleid verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 10304 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 5.112 Description:30'x 24'x 21'det res gar 438-Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ othe Private <br /> r <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road dcprez-000-08263 <br /> ❑ YES ❑ NO <br /> l <br /> y SHORELAND FLOOD ZONE WETLAND ! EC/SW NO. <br /> ❑ YES LA NO ❑ YES NO ❑ YES Q' NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1200 <br /> 21 Sq.Ft.480 Sq.Ft.720 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $26,000.00 <br /> 2 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $140.00 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 or Q <br /> plans submitted will invalidate the permit. `c--- V� - (—Z7—f( <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/27/2016 RLB <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials/-N 7 ^() 2 . / c0 P/K <br />