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DANE COUNTY ZONING PERMIT DCPZP-2017-00005 Page oft OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE WILLIAM J LOBENSTEIN (608) 516-3012 WILLIAM LOBENSTEIN (608) 516-3012 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 3272 DEERFIELD RD 3272 DEERFIELD RD (City,State,Zip) (City,State,Zip) DEERFIELD, WI 53531 DEERFIELD, WI 53531 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0812-344-9045-0 TOWN OF MEDINA 34 SE SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 584 J uedes LN subject to field verification.) LOT BLOCK I C.S.M.NO.or PLAT NAME 2 CSM 10439 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE RH-2 Rural Homes 4.1 Description:Single family residence(4 bedroom)w/shared driveway 101 -SFR (detached) District Category I Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Private 2016-00375 ❑ Other: ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road 8361 0 YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 4802 22 Sq.Ft.1340 Sq.Ft.2790 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $180,000.00 2 Sq.Ft 672 Sq.Ft. PERMIT FEE $410.15 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 SIGNATU"E: Own-r Ag-nt DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. 1 )" l ALA AP-- X i 20) OFFICE USE ONLY (form version 0.3.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 01/13/2017 DJ E 1 \/'.l YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials:X W d. .