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DANE COUNTY ZONING PERMIT DCPZP 2017 00039 Page 1 of 2 <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 <br /> E-MAIL ADDRESS E-MAIL AD 2ESS 6k.) j I ey t e x 1-e.'r + O C s@ <br /> bullseyeetenors @yahoo.com 0.k0 O . C O rt <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <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:detached accessory bldg.no sanitary fixtures 438-Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other <br /> no fixtures allowed <br /> r: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10984 0 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 /> 1812 <br /> 15 Sq.Ft. Sq.Ft.1812 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $12,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $185.90 <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 S NATURE: caner/Age a DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. , II. <br /> tom •', a/'ZZ/t <br /> OFFICE USE CNLY (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: fX 3 ^ a33 ( ti <br />