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DANE COUNTY ZONING PERMIT DCPZP INGPER7--00094 Pagel of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KATHRYN L DEBNER 1c Vvgj .Qz&L (608)239-9033 <br /> BILLING ADDRESS(Number,S eet) ADDRESS(Number,Street) <br /> 9 PIEDMONT CT <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53711 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mrezac20 @yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509-053-9860-1 TOWN OF OREGON 5 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1385 STORYTOWN RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 00799 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 2.4 Description:SFR 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2017-00005 <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10244 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES 0 NO ❑ YES 0 NO ❑ YES Vi NO se2017-0011 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5600 <br /> 21 Sq.Ft.2221 Sq.Ft.3379 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $320,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $470.00 <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 SIGNATU- : Owner/Ag: DATE:3 <br /> Ordinances.Any unauthorized change from the information or A _`�) ' a3 <br /> plans submitted will invalidate the permit. ,111 <br /> /��A�. . (7 <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/17/2017 HJH3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: . & . 1 7 P +'I f( <br />