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DANE COUNTY ZONING PERMIT DCPZP 2017-00256 Page oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ADAM J KUEN (920) 277-1680 quality west const. (608) 798-3774 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 10686 ROWLEY RD PO Box 12 <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 MOUNT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0606-052-8150-0 TOWN OF BLUE MOUNDS 5 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3163 County Highway F <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 11179 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-2 Residence 5.7 Description:Single family residence,3 bedrooms and deck. 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other <br /> 1.3— 2017-00116 <br /> r. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES la NO ❑ YES ® NO ❑ YES ® NO EC2017-0098 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> X /9 J <br /> 627 <br /> 28 Sq.Ft.968 . Sq.Ft. 1731 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $350,000.00 <br /> 2 Sq.Ft.896 Sq.Ft. PF}2MIT FEE -0 „ <br /> + 71.(047.03 3 ( 7. -s <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 SIGNATUR • . 0 - /Agent DATE: <br /> Ordinances.Any unauthorized change from the information or / <br /> plans submitted will invalidate the permit. r S-3//-f <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQU ED? DATE ISSUED rALS 1st INSPECTION DATE INITIALS <br /> 05/11/2017 DJE1 <br /> YES x/r, DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS• <br /> Initials: <br />