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DANE COUNTY ZONING PERMIT DCPZP 2016 00773 Page 1 of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ANDY MEINHOLZ (608) 831-8103 MARTEN BUILDING & DESIGN (608)212-6934 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6813 COUNTY HIGHWAY K PO BOX 64 <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 SUN PRAIRIE, WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MEINHOLZEXCAVATING@ GMAIL.COM RADY @MARTENBUILDING.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0911-184-6118-0 TOWN OF BRISTOL 18 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2924 FERN DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 18 BURNSON'S RIDGE <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture .760 Description:SFR 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial 0 Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: <br /> Private 13-2016-00364 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-AII Other <br /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO 0 YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5077 <br /> 18 Sq.Ft.2008 Sq.Ft.3069 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $438,107.74 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $430.78 <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 o e..ances. <br /> Owner&Agent hereby agree to comply with all Dane County •w • •ent DATE: <br /> Ordinances.Any unauthorized change from the information or i <br /> plans submitted will invalidate the permit. - �% , �� _ l( <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUI? I? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 2/2016 HJH3 <br /> S ® NO DATE REVIEW <br /> 12 00ED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: /7 <br />