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DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 0112 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOSH T USELMAN (608) 535-2808 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3317 BRUGGER PL <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JUSELMAN1 @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-362-9845-0 TOWN OF BLOOMING GROVE 36 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3316 SIGGELKOW RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 14423 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 4 Description:SFR WITH DECK AND PORCH 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13-2017-00039 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 11010 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ED YES ® NO ❑ YES 0 NO ❑ YES ® NO EC2017-0049 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5892 <br /> 22 Sq.Ft.2372 Sq.Ft.3520 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $278,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $491.90 <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 SIGNAT 4 " , : Ow / ent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ' X tom Z1/4( ( <br /> OFFICE USE'ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/24/2017 PMK2 <br /> ❑ YES ® NO DATE REVIE ED INITIALS 2nd INSPECTION DATE INITIALS <br /> J <br /> Initials: J/!! Li.■ + ) Nir e M K <br />