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DANE COUNTY ZONING PERMIT DCPZP2016-00767 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE 9 AGENT/CONTRACTOR NAME PHONE <br /> WILLIAM D CORFMAN (608) 515-2078 RANDY LANDPHIER (608) 438-6729 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4687 W RUTLAND RD 615 WINDSOR LANE <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 EVANSVILLE, WI 53536 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> davecorfman @gmail.com randy @edisondesignbuild.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0510-303-8090-9 TOWN OF RUTLAND 30 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4687 W RUTLAND RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 04963 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 3.95 Description:single family residence and covered porch 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: /3 - LO 1 6-00 3 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> •S ; / ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND e! EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4816 <br /> 20 Sq.Ft. 1728 Sq.Ft.3088 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $234,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $411.20 <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 SIGN. 'R. . O 'er/Age DATE: <br /> Ordinances.Any unauthorized change from the information or / l� <br /> plans submitted will invalidate the permit. /�/ — U —i. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/28/2016 SSA1 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: , a ^ ara - j( ? M <br />