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DANE COUNTY ZONING PERMIT DCPZP-201700070 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS B BENGSCH (608)444-9721 John Mulligan (715) 892-2164 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1691 TAM 0 SHANTER TRL 7840 Leary Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 Minocqua, WI 54548 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jtm7840 @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0911-122-0601-5 TOWN OF BRISTOL 12 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1691 TAM 0 SHANTER TRL <br /> subject to field verification.) <br /> LOT BLOCK 1 C.S.M.NO.or PLAT NAME <br /> 1 FOX HILL <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-1 Residence .735 Description:sunroom addn 434- Residential Addition <br /> District <br /> Category ® Residential 0 Commercial D Agricultural SEWER SANITARY PERMIT NO. <br /> Other Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 02 .71C, 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES 0 NO 0 YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) 1BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 168 <br /> 13 Sq.Ft. Sq.Ft. 168 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $35,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $62.60 <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 SI N•TURE: Own-r/€e t ) DATE: <br /> Ordinances.Any unauthorized change from the information or .i` ‘ / <br /> plans submitted will invalidate the permit. `' 3_ —0017 <br /> OFFICE USE ONLY (form vtision 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/08/2017 SC W 1 <br /> 0, YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 4/'N — / P ti K <br />