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DANE COUNTY ZONING PERMIT DCPZP 2017 00169 Pagel oft OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DASSOW TR,GERALD&MARY T (715) 966-9028 DUANE FARWELL BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 1190 NIRA LN (City,State,Zip) (City,State,Zip) EDGERTON, WI 53534 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0512-054-5567-0 TOWN OF ALBION 5 SE SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 1190 NIRA LN subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 7 BLUE MEADOW ESTATES ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE R-1 Residence 0.48 Description:1560'pool 329 -Other District Category J Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION E-AII Other 8383 YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 450 0 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 0 Sq.Ft. Sq.Ft. PERMIT FEE $83.75 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. OFFICE USE ONLY (form version 03.01.01) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 04/14/2017 SSA1 ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: