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DANE COUNTY ZONING PERMIT DCPZP 2017-00025 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PREMIER BUILDERS INC (608) 849-6770 PREMIER BUILDERS INC (608) 849-6770 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 102 N HOLIDAY DR 102 N HOLIDAY DR <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 WAUNAKEE, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JEANETTE.ACKER@TDS.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0909-363-6505-0 TOWN OF VIENNA <br /> 36 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME I r ST.TYP� <br /> (Assignment of new address is A )rnya, 1�n ! e— <br /> subject to field verification.) �ddYY�� 1�J �+t/I (/V w ���...kkkJJJ r' <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 75 NATURE VALLEY CONSERVATION NEIGHBORHOOD-1ST ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence .4 Description:SFR W/DECK W/PORCH 101 -SFR (detached) <br /> District <br /> Category ® Residential Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 10246 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO - YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5872.5 <br /> 19.25 Sq.Ft.2033 Sq.Ft.3839.5 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $400,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $490.44 <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 NATU- • • er/A DATE: <br /> Ordinances.Any unauthorized change from the information or ,'. , <br /> plans submitted will invalidate the permit. •! //S <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INI ALS 1st INSPECTION DATE INITIALS <br /> ® Y ❑ NO REVIEWED <br /> 02/15/2017 HJH3 <br /> DATE REVIEW INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: a <br />