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DANE COUNTY ZONING PERMIT DCPZP 2017-00408 Page 1 oft OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE CLAUDIA MOURAO NEHRING (608) 609-3608 Recreational Concepts Inc. (608) 835-2780 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 10455 SUTCLIFFE RD 121 N. Main St. (City,State,Zip) (City,State,Zip) BLACK EARTH, WI 53515 Oregon, WI 53575 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0806-332-9773-9 TOWN OF BLACK EARTH 33 NW SE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 10455 SUTCLIFFE RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 3 CSM 07959 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE RH-3 Rural Homes 9.49 Description:above ground swimming pool 328 -Other Non-Residential District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Other:pool Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ES iA NO ❑ YES ® NO ❑ YES ® NO HEIGHT v. -eet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 450 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $5,000.00 Sq.Ft. Sq.Ft. PERMIT FEE $0.00 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 SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. OFFICE USE ONLY (form version 03.01.01) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 07/07/2017 DJ E1 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: