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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DC PZP-2018-00057 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MIA K KAHL (608)577-7651 <br /> BILLING ADDRESS(Number,Street) r't tK ADDRESS(Number,Street) <br /> - e - &s ►1-7 2 Mcple Grave Rd 31212eis <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kahlt @hotmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0512-053-9700-7 TOWN OF ALBION 5 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1252 US Highway 51 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 02384 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes 4.85 Description:sfr w/porches 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13201800039 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 6070 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 28 Sq.Ft.2127 Sq.Ft.2991 <br /> 5898 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $620,000.00 <br /> 2 Sq.Ft.780 Sq.Ft. PERMIT FEE <br /> $492.35 <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 /> w■ w.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 SIGNATU• E: Owne Age DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 1 ! — '?4\31� 20 I <br /> OFFICE USE ONLY (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/02/2018 SCW1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials:JM <br />