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DANE COUNTY ZONING PERMIT DCPZP 2017-00663 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LARRY S SORNBERGER (608) 873-8314 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1996 COUNTY HIGHWAY W <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0612-301-9001-0 TOWN OF CHRISTIANA 30 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1996 COUNTY HIGHWAY W <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 08196 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (4)Agriculture 5.793 Description:GREAT ROOM AND GARAGE ADDITION 434- Residential Addition <br /> District <br /> Category ® Residential Commercial D Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO ❑ YES ® NO YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1525 <br /> 15' MEAN Sq.Ft. Sq.Ft. 1525 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $65,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $164.38 <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 or•inances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN' URE: Ow - /Ag t DATE: <br /> Ordinances.Any unauthorized change from the information or I /7 <br /> plans submitted will invalidate the permit. #'i j # � ,� lv- p�(//� <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY RE•UIRED? DATE ISSUED INITI•f 1st INSPECTION DATE INITIALS <br /> ��'YES ® NO 10/02/2017 SLJ3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: • <br />