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DANE COUNTY ZONING PERMIT DCPZP 2017 00436 Pagel of OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DALE L STENJEM (608) 423-4715 TIG Pursuits (608)437-4442 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 3012 STATE HIGHWAY 134 109 Agnes Ct. (City,State,Zip) (City,State,Zip) CAMBRIDGE, WI 53523 MOUNT HOREB, WI 53572 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0612-011-8600-0 TOWN OF CHRISTIANA 1 NE NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 3144 STATE HIGHWAY 134 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 49.1 Description:Single family residence 101 -SFR (detached) District 3 bedrooms Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Private 2017-00157 ❑ Other: ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION A-US or State Highway ❑ YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES I NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 4876 22.5 Sq.Ft.2090 Sq.Ft.2786 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $278,225.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $415.70 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 07/18/2017 DJE1 ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: