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DANE COUNTY ZONING PERMIT DCPZP 2016-00579 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BLAINE E HAUGEN (608) 333-2451 Tim Dahl (608) 220-2100 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1562 THOREAU DR N4321 Poplar Ave <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 Cambridge, WI 53523 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> blaineandlisah @gmail.com Dah125 @charter.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-211-7626-0 TOWN OF DEERFIELD 21 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3844 US Highway 73 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13201 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .698 Description:sfrw/porch 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial El Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13201600262 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO, VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES El NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4358 <br /> 18 Sq.Ft. 1221 sq.Ft.1916 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $345,000.00 <br /> 2 Sq.Ft. 1302 Sq.Ft. PERMIT FEE <br /> $376.85 <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 NAT U. A091 ent DATE: <br /> Ordinances.Any unauthorized change from the information or vT <br /> plans submitted will invalidate the permit. ' ' G* ►,' .7"'. "`(j <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/02/2016 SC W 1 <br /> ry0 YES 1:1 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initia 3 ` <br />