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DANE COUNTY ZONING PERMIT Page of DCPZP 2016-00799 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DONALD C TIERNEY (605) 555-5555 Marten Building & Design (608)212-6934 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 3564 EGRE RD PO Box 64 (City,State,Zip) (City,State,Zip) DEFOREST, WI 53532 Sun Prairie, WI 53590 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0911-303-0420-0 TOWN OF BRISTOL 30 SW NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 3119 Vanessa WAY subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 40 BRISTOL GARDENS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE A-1 Agriculture 0.698 Description:Single family residence 101 -SFR (detached) District 5 bedrooms Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private 2016-00378 ROAD CLASSIFICATION (REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road ❑ YES El NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ❑ NO ❑ YES ❑ NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 6224 30-2 Sq.Ft.1707 Sq.Ft.3036 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $704,000.00 2 Sq.Ft. 1481 Sq.Ft. PERMIT FEE $516.80 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County S1' NAT - Owne Agen .- I •TE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. t2 /Z 2 A:;. OFFIC'c USF ONLY (fora version 03.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 12/28/2016 DJ E1 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: