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DANE COUNTY ZONING PERMIT DCPZP 2016-00733 Page'I of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEFFREY S IRELAND (608)220-2098 Olson Brothers Building (608)279-5760 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 605 STONEHAVEN DR 4544 Winnequah Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 Monona, Wi 53716 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeff.ireland @m3ins.com obros @charter.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-252-9553-3 TOWN OF BURKE <br /> 25 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5207 THORSON RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 3 CSM 09398 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 5.01 Description:detached garage-no sanitary fixtures allowed 438-Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: <br /> Private no fixtures allowed <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES 66 NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1500 <br /> 12 Sq.Ft. Sq.Ft. 1500 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $45,000.00 <br /> I Sq.Ft. Sq.Ft. PERMIT FEE <br /> $162.50 <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 ■ww.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 NATU- : 0 ner/Agen DA E: <br /> Ordinances.Any unauthorized change from the information or ........ <br /> plans submitted will invalidate the permit. • '6 , 26' t <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS I 1st INSPECTION DATE INITIALS <br /> 11/03/2016 SC W 1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> - Initials: <br /> — <br />