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DANE COUNTY ZONING PERMIT DCPZP 2017 00441 Page 1 of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOSHUA R NORDSTRUM (6) , Jay Nordstrum (608)291-2356 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5520 SHEIL DR 35,917S 450 Alpine Pkwy <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 Oregon, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509-153-4086-8 TOWN OF OREGON 15 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5520 SHEIL DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 36 HILLCREST HEIGHTS-2ND ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-1 Residence 0.75 Description:roof addition over existing deck 434 - Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZON.Q i C.U.P.NO. VARIANCE NO DEED RESTRICTION <br /> E-All Other El YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR a Re TOTAL SQUARE FEET , AR <br /> 13 Sq.Ft. Sq.Ft- " <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $3,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE n.Go <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 premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA RE: Owner/Ag nt TE: <br /> Ordinances.Any unauthorized change from the information or r > / i0,?)/4 /f-j <br /> plans submitted will invalidate the permit. h. - , l <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/19/2017 DJ E1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 7 . &a - / 7 t)ltiY <br />