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DANE COUNTY ZONING PERMIT DCPZP 2017-00010 Pagel oft OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DEREK M KOLKOVICH (608)516-1657 Cleary Building Corporation 608-3 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 1155 BLACK OAK TRL 190 Paoli St. (City,State,Zip) (City,State,Zip) DEERFIELD, WI 53531 Verona,WI 5359 E-MAIL ADDRESS E-MAIL ADDRESS cheriheitkamp @yahoo.com tleeser @clearybuilding.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0712-054-4210-0 TOWN OF DEERFIELD 5 SE SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 1155 BLACK OAK TRL subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 1 CSM 10341 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE R-1A Residence Description:48'x 36'x 14'det res gar 438-Garage District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road DCPREZ-0000-07774 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES 0 NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 1536 14 Sq.Ft. Sq.Ft.1536 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $34,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $165.00 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 ordin. • es. Owner&Agent hereby agree to comply with all Dane County SIGNAT 4 RE: OLJ, - •• • DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. 1 / 1 d /7 OFFICE JS'ONLY (form version 03.01.00) SURVEY REQUI- D? DATE ISSUED I PALS 1st INSPECTION DATE INITIALS 01/30/2017 RLB I/ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials !'P. - - -