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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CARR LIVING TR Josh Fugate (608) 882-5270 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 176 N UNION RD 176 N. Union Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 Brooklyn, WI 53521 l <br /> E-MAIL ADDRESS E-MAIL ADDRESS A v +I'S a re t X fe T i o f S <br /> bullseyeeteriors @yahoo.com 6 yak C C+ , CO m <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0510-342-9745-0 TOWN OF RUTLAND 34 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 134 N Union RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14267 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2 Description:sfr 4 bdrm w/porches and at grade patio 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13201700024 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10984 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO contacted <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5953 <br /> 19 Sq.Ft. 1930 Sq.Ft.3465 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $202,240.00 <br /> 2 Sq.Ft.558 Sq.Ft. PERMIT FEE <br /> $496.47 <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 SI NATURE: •wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / ...a A Iii,, Z Z2 / 7 <br /> OFFICE USE ON1_Y (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/22/2017 SC W 1 <br /> ` ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials\'�f'` <br /> IT —1;?(, / 1 Q iv <br />