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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2017-00085 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRIAN J JAEGER Meigs Inc. (608)767-2729 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5209 PAULSON RD PO Box 412 <br /> (City,State.Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 Black Earth, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ken @meigsbuilds.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-352-0737-0 TOWN OF BLOOMING GROVE 35 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 3383 Jenness AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 107 APRIL HILL-1ST ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-2 Residence Description:sfr no porches/decks 101 -SFR(detached) <br /> District <br /> Category 0 Residential ❑ Commercial 0 Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ other: Private 13201700053 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P,NO. VARIANCE NO. DEED RESTRICTION <br /> E-AII Other <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> O YES ® NO ❑ YES ® NO o YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 18 4311 <br /> sq.Ft.1811 Sq.Ft.2500 <br /> PROJECT COST <br /> Na OF STORIES 2nd FLOOR 3rd FLOOR $320,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $373.33 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 8 Agent hereby agree to comply with all Dane County SIGNAj,TURE' • /Agent DAT : <br /> Ordinances.Any unauthorized change from the information or �/��i�fi� <br /> plans submitted will invalidate the permit. ,Ale:f/ ‘' <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/16/2017 SCW1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />