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DANE COUNTY ZONING PERMIT Page 1of2 <br /> DCPZP-201600663 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ERIC A JEPPSON JENNA SNIDER (608) 217-7435 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2005 SKYLINE DR 1117 HAMILTON ST#101 <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ericjeppson @gmail.com JMKRASKA@GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0611-292-5078-1 TOWN OF PLEASANT SPRINGS 29 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2005 SKYLINE DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 08505 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-3 Residence .136 Description:SFR 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv Streets <br /> ❑ VES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES ® NO ❑ YES ® NO se2016-0368 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 3436 <br /> 22 Sq.Ft.750 Sq.Ft. 1278 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $249,586.00 <br /> 2 Sq.Ft. 1408 Sq.Ft. PERMIT FEE <br /> $307.70 <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 a&es.Agent <br /> Any unauthorized hors agree d change with all Dane County SIGNATU-E: O 1i 1ff1.. a l DATE:tl b <br /> Ordinances.Any unauthorized than a from the information or Al ''''GGII'f�G�(/l((JJ ` <br /> plans submitted will invalidate the permit. L~ U <br /> I <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/10/2016 HJH3 <br /> YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE <br /> 1INITIALS <br /> Initials: <br /> < - - <br />