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DANE COUNTY ZONING PERMIT DCPZP-2017-00033 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PH E <br /> NATHRIIEL D BRAZY (608) 347-2503 Dicey Cu,5 Q ; � 08� 237-4'750 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number, treet) <br /> 506 LONE PINE WAY <br /> 3 0(1'0 rk5i-/e .f-©n Cr OSsln <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 l.) n Vs-a ‘ r t e ) NA 335 90 <br /> E-MAIL ADDRESS E-MAIL ADDtWSS 1 N` <br /> NDBRAZY @TDS.NET t)S J R r IV 1 C 'IS ; 1— E ` fv ET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0608-263-9160-0 TOWN OF VERONA 26 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1948 RANGE TRL <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 12509 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 4.702 Description:single family home 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2017-00003 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2573 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 8010 <br /> 24 Sq.Ft.2630 Sq.Ft.4200 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $650,000.00 <br /> 2 Sq.Ft. 1 180 Sq.Ft. PERMIT FEE <br /> $650.75 <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: Owne gent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. C: e-,■ -- 0.,------- .0 --cg"l <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/20/2017 SSA1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: .l ^ " ! /(n�,7. f K'/ <br />