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DANE COUNTY ZONING PERMIT Page of DCPZP 2017-00091 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE SIMS LIVING TR,JW&JULIE (608) 225-4500 AARON HARRISON (608) 535-0279 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 1384 COUNTY HIGHWAY W 3205 BAILEY RD (City,State,Zip) (City,State,Zip) STOUGHTON, WI 53589 SUN PRAIRIE, WI 53590 E-MAIL ADDRESS E-MAIL ADDRESS DUBS @SI MSEXTERIORS.NET AARON @SIMSEXTERIORS.NET PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0512-054-8560-0 TOWN OF ALBION 5 SE NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 1384 COUNTY HIGHWAY W subject to field verification.) LOT BLOCK I C.S.M.NO.or PLAT NAME 1 CSM 14202 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE RH-4 Rural Homes 12 Description:RESIDENTIAL ADDITION 434- Residential Addition District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION B-County Highway 10916 ❑ YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. 0 YES ❑ NO ® YES ❑ NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 2628 24.5 Sq.Ft. 1278 Sq.Ft. 1350 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $150,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE$247.10 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIG 1•TURE:''wner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. '3-1 )-p OFFICE USE ONLY (form version 03.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 03/17/2017 HJH3 YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS is s.