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DANE COUNTY ZONING PERMIT ZONING DCPZP-2018-00049 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> NATE RUSCH (715)409-0098 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5447 PATRIOT DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ncrusch @gmaii.com <br /> PARCEL NO TOWNSHIP SECTION 1/4 1/41/4 <br /> 4 SE NW <br /> 0506-044-8700-0 TOWN OF PERRY <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10403 DOCKEN 'Re' <br /> subject to field verification.) b <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12949 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes X07"" Description:new house and screen porch 101 -SFR(detached) <br /> District a i, 9 07 <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2018-00027 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10175 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> se2018-0006 <br /> ® YES ❑ NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5623 <br /> 23 Sq.Ft.2066 Sq.Ft.3557 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $650,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $471.72 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 Dan- County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinance-. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Own=�g� ,a, DATE: <br /> Ordinances.Any unauthorized change from the information or _ „ /�- d� Q <br /> plans submitted will invalidate the permit. �� �/ U <br /> OFFICE USE ONLY (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/23/2018 SSA1 <br /> I„ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: .4� A2- G— , 7 ?MK <br />