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DANECOUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2017-00145 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME <br /> CASSANDRA M VANDERWALL (608) 318-0819 PHONE <br /> BILLING ADDRESS(Number,Street) <br /> 6762 PEACEFUL CT ADDRESS(Number,Street) <br /> (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 (City,State,Zip) <br /> E-MAIL ADDRESS <br /> cassie.vanderwall @gmail.com E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION <br /> 1/4 1/4 1/4 <br /> 0911-291-3067-3 TOWN OF BRISTOL 29 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION <br /> STREET NAME <br /> (Assignment of new address is 6762 PEACEFUL ST.TYPE CT <br /> subject to field verification.) <br /> LOT !BLOCK I C.S.M.NO.or PLAT NAME <br /> 57 PRAIRIE VIEW HEIGHTS-2ND ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition <br /> R-1 Residence 0.51 Description:chicken coop CENSUS CODE <br /> District 329-Other <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER <br /> SANITARY PERMIT NO <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. <br /> VARIANCE NO. DEED RESTRICTION <br /> E-AII Other 1697 <br /> SHORELAND FLOOD ZONE ❑ YES ® NO <br /> WETLAND EC/SW NO <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT <br /> 1st FLOOR TOTAL SQUARE FEET <br /> 12 <br /> Sq.Ft. Sq.Ft. 100 100 <br /> NO.OF STORIES PROJECT COST <br /> 2nd FLOOR 3rd FLOOR $57.50 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $15.00 <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 <br /> noted on the submitted plans and comply with the applicable zoning ordianceslt , 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 <br /> Ordinances.Any unauthorized change from the information r SIGNATURE:�Owner/Agent DATE: <br /> plans submitted will invalidate the <br /> permit. // <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE <br /> 04/04/2017 SSA1 INITIALS <br /> ❑ YES ® NO DATE REVIEWED INITIALS <br /> 2nd INSPECTION DATE INITIALS <br /> Initials. (Ill/ <br />