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DANE COUNTY ZONING PERMIT DCPZP 2017 00206 Pagel of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RAMI ABUROMIA (608) 333-1865 JG DEVELOPMENT (6 Q) s'3 -6 is/ <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1993 STATE HIGHWAY 92 4070 E BRIGHAM RD <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 BLUE MOUNDS, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> raburomia @yahoo.com �� e S;.CCL(ti C"eVeI��rt?n'� . CV'14 <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0607-293-8130-0 TOWN OF SPRINGDALE 29 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 9169 MALONE RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 1 CSM 14456 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture Description:new house 101 -SFR (detached) <br /> District i 5 e G <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private 13-2017-00101 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-" ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ec2016-0457 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4565 <br /> 25 Sq.Ft. 1771 Sq.Ft.2794 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $470,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $392.38 <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 SIG. • RE: Owner/At - t DATE: <br /> Ordinances.Any unauthorized change from the information or •plans submitted will invalidate the permit. —AMP -+ <br /> OFFICE U3E ON!_' (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIAL`. 1st INSPECTION DATE INITIALS <br /> 04/26/2017 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS P 2nd INSPECTION DATE INITIALS <br /> )`, <br /> Initials: "c,), ?— 1 7 t_j_kl:= <br />