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DANE COUNTY ZONING PERMIT DCPZP 2018 00006 Page1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RONALD R KLAAS (608)225-1550 PREMIER BUILDERS INC. (608) 849-6770 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 796 ALPINE PKWY 102 N. HOLIDAY DRIVE <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 WAUNAKEE, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SSWENSON @CUNA.COOP JEANETTE.ACKER @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509-072-9685-0 TOWN OF OREGON 7 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1286 JUDD RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 13273 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 9.5 Description:SFR WITH COVERED PORCH. 101 -SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2017-00389 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10367 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> O YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> SM2017-0461/EC2017-0381 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 9209 <br /> 30 Sq.Ft.2946 Sq.Ft.4939 <br /> PROJECT COST <br /> NO.OF STORIES '2nd FLOOR 3rd FLOOR $890,000.00 <br /> 2 Sq.Ft. 1324 Sq.Ft. PERMIT FEE <br /> $740.68 <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 SIGNATURE: Owner/A! t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 01/08/2018 PMK2 <br /> 5 <br /> Initials: <br /> ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />