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DANE COUNTY ZONING PERMIT ;';;=65 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANIELLE ZILM (608) 886-6524 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4129 DWIGHT DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DANIELLEKNORR@ATT.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-104-4101-8 TOWN OF BURKE 10 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5875 POND RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 LOTHE WOODS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence .46 Description:SFR W/DECK 101 -SFR (detached) <br /> District <br /> Category ® Residential O Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> El Other Private 13-17-106 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other 1664 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES El NO ❑ YES ® NO 0 YES ® NO SE2017-0186 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4654 <br /> 15 Sq.Ft.1803 Sq.Ft.2851 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $250,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $399.05 <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 NATURE: ner/A• - t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. O� <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ® YES 111 NO 06/21/2017 HJH3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />