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DANE COUNTY ZONING PERMIT DCPZP 2017-00044 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CHRISTEN J RING (608) 575-0089 Custom Builders (608) 553-2609 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2901 CURRY RKWY UNIT 8 /U 4, Yr 5551 Farmers Ridge Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53713 OC// Ifs w,_. (5i-by Highland, WI 53543 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> chris.j.ring @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0508-142-8040-0 TOWN OF MONTROSE 14 NW NE <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1081 ANN ST <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 11643 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 4.584 Description:detached accessory bldg.no sanitary fixtures 438-Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 9313 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> /NI\Q 1216 <br /> 17 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $17,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $141.20 <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 /> nearor 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 /> 1-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 SIGNATURE: Owne /Agent DATE: <br /> Ordinances.Any unauthorized change from the information or ____...--------- <br /> plans submitted will invalidate the permit. Z—W—( , <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/24/2017 SCW1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial (3 q 1 11 P r 9 lc <br />