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DANE COUNTY ZONING PERMIT DCPZP-2016-00736 Pagel of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ANDREW J DAVIS (608) 260-5038 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 316 TVEDT DR <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> andy773492 @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-204-8110-0 TOWN OF BLUE MOUNDS 20 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10620 W BLUE MOUNDS RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13951 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes Description:new house 101 -SFR (detached) <br /> District „2 . 7(? <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2016-00319 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10759 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 25 Sq.Ft.858 Sq.Ft.1505 3213 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR p-5 0 3rd FLOOR $246,000.00 <br /> 2 Sq.Ft,$raa't- Sq.Ft. PERMIT FEE <br /> $290.98 <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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ,r, I 1 Z — /C' <br /> OFFICE uSE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/04/2016 SSA1 <br /> ® YES ❑ NO DATE REVIEWED l INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: �c C_ / 1 „ Y- / K <br />