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DANE COUNTY ZONING PERMIT DCPZp2016-00654 Pogo 1of2' <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RODNEY U RENZ (608)837-6633 Cushman Construction LLC (608)798-2001 <br /> BILLING ADDRESS(NUrnoer,Street) ADDRESS(Notutzer.Street) <br /> 2715 HILLTOP 2710 Elmwood Circle <br /> IC Iy,Stets,Z.u) (C'ly,State.214 <br /> SUN PRAIRIE, WI 53590 Cross Plains,WI 53528 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> krenz66@hatmail.corn licushman@T charter.net <br /> PARCEL-NO, TOWNSHIP SECTION 1/4 1/41/4 <br /> 0911-213-9305-0 TOWN OF BRISTOL <br /> 21 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment or new address Is 2612 HAPPY VALLEY RD <br /> subject to field veriticallon.) <br /> LOT BLOCK C.S.M NO.or PI M NAME <br /> 1 CSM 14141 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT° New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.21 DuscnoLrxr sfr w/rrt coy poi,open deck 101 -SFR(detached) <br /> District <br /> Ca+.egory Resdentrn' 0 Contrrercta' 0 AgncutTU:at SEWER SANITARY PERMIT NO. <br /> Private 13-2016-00305 <br /> ❑ Otr,e, <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road dcpzp-2Q15-10890 <br /> ❑ YES ❑ Na <br /> SHORELANO FLOOD ZONE WETLAND EC/SW NO, <br /> n YES t) NO ❑ YES Ca NO (j YES D NO ec-2 016 0 <br /> HEIGHT On feel) BASEMENT let FLOOR TOTAL SOUARE FEET <br /> 7560 <br /> 30 sq.FT.3180 Sq.FL 4380 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR lid FLOOR $455,000.00 <br /> Sq.Ft. PERMIT FEE <br /> Sq Ft. <br /> $617.00 <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 w or <br /> other penalties or costs. For more information, visit the Department of Natural Resources 3t <br /> www.dnr.state.wi. s or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning s for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE:Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or / r ,- <br /> plans submitted will Invalidate the permit. `7.„ A /4-/.2-• <br /> OFFICE USE ONLY ((ornt version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS Is INSPECTION DATE INITIALS <br /> 10/04/2016 RIB <br /> tin YES 9) NO DATE REVIEWED INH IALS 2nd INSPECTION GATE INITIALS <br />