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} <br /> Apelibation Number:APP-25509 <br /> DANE COUNTY ZONING PERMIT Z°NING PERMIT "°• <br /> r ZP20080699 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GENE DERRICKSON (608)644-1012 SAME AS OWNER <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 6647 HERBRAND RD <br /> (City.State,Zip) (City,State,Zip) <br /> SAUK CITY,WI 53583 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. I TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0907-294-9820-4 ROXBURY 29 SE SE <br /> NUJ:til Li 4:i1W11,1•1:14* HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 6647 HERBRAND RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS: METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New (I Addition/Alteration CENSUS CODE <br /> RH-2 5.02 Description:GARAGE, MUDROOM 434 - RES ADD <br /> CATEGORY X Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: ❑Public gl Private ' <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C ❑Yes ❑No <br /> SHORELAND FLOOD ZONE WETLAND pI EC/SW NO. <br /> ��t1 <br /> ❑Yes pI No ❑Yes X No ❑Yes X No <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 648 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 17,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. $ 98.00 <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner 8,Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent. DATE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit A. - (e9--/ -. 8' <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTIO DIE INIT 401:41 <br /> ❑Yes A No 19 Sep 2008 DJE1 fj' 0 D 7 • <br /> DATE REVIEWED INITIALS 2nd INSPEr pa j■TE? INITIA Initials: C]J 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. MODIFICATION TO THE <br /> Conditions. PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF A�fS' t��CATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. <br /> INITIALS(\ <br /> 545-112(12/05) GCS-single <br />