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24E COUNTY ZONING PERMIT ZONING PERMITNO."' r ,r. `` :Pi901QE2' <br /> DCPZP-2017-00169 <br /> AGENTiOONTRACT R <br /> .5t'. �'., `;=OWNER INFQRMATIQN.� ..- .<, ,; r. ., INFQRMATION i r '; ;t'° <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> 'OW TR,GERALD&MARY T (715)966-9028 DUANE FARWELL <br /> i <br /> BIL LAG ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1190 NIRA LN <br /> 1 <br /> ,C,,o,state,Lip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E.r,lAil ADDRESS E-MAIL ADDRESS <br /> ,lxPAR.cgln NQ. s u, uvf ,r *: .v ' .'TOWNSHII rr-La SECTION 1/4 <br /> 1/4 1/4 <br /> 0512-054-5567-0 TOWN OF ALBION 5 SE SW <br /> ,r-449#03vAgtm4v,%, HOUSE NO ST.DIRECTION STREET NAME <br /> ST.TYPE <br /> (Assignment of new address is 1190 NIRA LN <br /> subject to field verification.) <br /> li i.:i BLOCK C.S.M.NO.or PLAT NAME <br /> 7 BLUE MEADOW ESTATES <br /> [ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 0.48 Description:15'x30'pool 329-Other <br /> District <br /> Cat�-yc,, rs6 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other Private <br /> ROAD LASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-AII Other 8383 <br /> ❑ YES 10 NO <br /> SriORr:LAND FLOOD ZONE WETLAND EC/SW NO. I <br /> L YES NO 0 YES ® NO ❑ YES ® NO <br /> ril.,Grit ;:(-1 Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 450 <br /> 0 Sq.Ft. Sq.Ft. <br /> TORIES 2nd FLOOR 3rd FLOOR <br /> $50,00s.:. <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $83.75 <br /> i, the undersigned, am the owner of the property or an authorized agent acting . •-half of the owner . <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be e - -: 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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> 'other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> vvvvw.dnr.state.wi.uf or contact the Department of Natural Resources Service Center. <br /> ',-• �. 4 ..__ <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 /> � <br /> Owne;&Agent hereby agree to comply with all Dane County SIGN RE: Own gent DATE: <br /> dii,ances.Any unauthorized change from the information or <br /> ( 1-1 / 7 / <br /> plans submitted will invalidate the permit. /(/(4/1t/ 11. <br /> F ,i- w aG ^^ a <br /> . ,} r GFFICJISIr ONLY 1 <br /> `'lfvim ylon 041 Q11+: <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/14/2017 SSA1 <br /> 0 YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />