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DANE COUNTY ZONING PERMIT DCPZP 2017-00290 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PETER M CURTIS (608) 835-6555 DAVE BUDDEN (608) 767-4622 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5586 RALPH RD 1527 HWY 14 P.O. BOX 412 <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 BLACK EARTH, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PMCURTIS55 @GMAIL.COM dave @meigsbuilds.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509-164-6225-2 TOWN OF OREGON <br /> 16 SE SE <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5586 RALPH RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 25 HILLCREST HEIGHTS-1ST ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE . <br /> R-1 Residence .70 Description:305(24'accessory building 438 -Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 1657 D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 720 <br /> 11.8 Sq.Ft. Sq.Ft.720 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $35,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $104.00 <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 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 premise-. by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning • din-nce <br /> Owner&Agent hereby agree to comply with all Dane County SIGN' ' RE: •wner/ g , / DATE: <br /> Ordinances.Any unauthorized change from the information or / S/ )�I 7 <br /> plans submitted will invalidate the permit. / <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/24/2017 SSA1 <br /> �❑ YES ® NO DATE REVIEWED INITIALS 1 2nd INSPECTION DATE INITIALS <br /> Initials: AMID--) S ^0),� --I r C�"�tL <br />