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DANE COUNTY ZONING PERMIT DCPZP-2017-00413 Page 1of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DAVID J HRUBY Meigs Inc. (608)767-2729 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 6531 MATZ RD PO Box 412 (City,State,Zip) (City,State,Zip) DANE, WI 53529 Black Earth, WI 53515 E-MAIL ADDRESS E-MAIL ADDRESS ken @meigsguilds.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0907-354-8000-5 TOWN OF ROXBURY 35 SE NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address Is 6531 MATZ RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE A-1 Ex Exclusive Ag 40 Description:sfr 101 -SFR(detached) District Category ® Residential ❑ Commercial 0 Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private 13201700214 ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO, DEED RESTRICTION C-Town Road ❑ YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. YES ❑ NO ❑ YES O NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 5700 15 sq.Ft.2070 Sq.Ft.3630 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $290,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $477.50 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATUR- + j gent--- DATE: Ordinances.Any unauthorized change from the information or / plans submitted will invalidate the permit. (. 1 10 1 OFFICE USE ONLY (form version 03.01.01) SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 07/10/2017 SC W 1 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: