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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2016-00629 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JUSTIN T JOZWIK (608)513-7687 James Campbell (608)513-7687 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9337 WIINTER FROST PL 1901 Tyroc Terrace <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53593 Mt Horeb, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> justinjozwik @yahoo.com jimcampbellwi @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0707-284-8041-0 TOWN OF CROSS PLAINS 28 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 8749 BLUFF VALLEY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 11482 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes Description:Single-family residence w/lower covered porch,upper 101 -SFR(detached) <br /> District level walkout <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2016-00245 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road dcpzp-0000-09192 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ❑ NO ❑ YES ❑ NO ec-2016-0--- <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 3874 <br /> 33 Sq.Ft.1168 Sq.Ft.2706 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $600,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $340.55 <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 SIGNA d : : 0 -r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / ' / >3 is`= 6 <br /> OFFICE USE ONLY (form version J3.01.00) <br /> SURVEY REQUIRED? DATE ISSUED ITIALS 1st INSPECTION DATE INITIALS <br /> 09/21/2016 RLB IK YES ® NO DATE REVIEW((((ED INITIA LS. 2nd INSPECTION DATE INITIALS <br /> Initials: : (t I�l ( <br /> - ! IV I` 1 V� <br />