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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ��v � D Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> D-79 7 Cu..)L O e Y1 Q LA( �, _I Deed Variance Restriction;CSM <br /> 1'`t-► Variance(# ) <br /> HOME PHONE CELL PHONE E-M I ADDRESS <br /> 6521'4 3`fr 1 Z°L (VOB-5) --)• % a Ipi,�j(t( ''►'1 itr�- /1 e'r Li Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan inrLtrfinn Innatinn <br /> DANE COUNTY ZONING PERMIT OCPZP-2017-00229 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SCOTT A BIGLER (608)437-1282 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2797 CAVE OF THE MOUNDS RD <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-083-8432-0 TOWN OF BLUE MOUNDS 8 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2797 CAVE OF THE MOUNDS RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 10527 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-1 Rural Homes 4.0 Description:deck addition 434-Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 8436 ❑ 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 /> 0 Sq.Ft. Sq.Ft. 23 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR __#Izfft —If <br /> 0-28)C Y CO <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $67.70 <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 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 /> www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br />