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DANE COUNTY ZONING PERMIT DCPZP201s 00,71 Page l oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DAN R KOK (608) 576-6225 Ed Hefty Contsruction (608) 212-0420 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2921 CAMP LEONARD RD 1036 Hillcrest Ln. <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI^53558 /� Oregon, WI 5357750 F.7.--T- y . <br /> E- .R ADDRESS be.R N I;O IG . C C 1 E MAI t•) ss �- N 14 CUI <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-081-8085-0 TOWN OF OREGON 8 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION - STREET NAME ST.TYPE <br /> (Assignment of new address is 5871 COUNTY HIGHWAY D <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 13475 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.895 Description:Single family r-r (,1 ��`-- <br /> District <br /> g y residence <br /> 10 I- G' 1``u� 0 <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other <br /> /2 2016-00342 <br /> r: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 1 D (?0 / <br /> ,� I ❑ YES 12 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES 0 NO ® YES El NO YES ® NO SE2016-0050 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6254 <br /> 22 Sq.Ft.2658 Sq.Ft.3596 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $398,700.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $519.05 <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. SI NATURE: Owner/Agent o!ATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ■ .� ):c9,—) —7G <br /> OFFICE_USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/01/2016 DJ E1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 1 r - ' 1 /W I /ti K <br />