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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2018-00090 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DIANNA C STALE (608)516-8025 <br /> BIWNG ADDRESS(Number,Street) ADDRESS(Number.Street) <br /> 4733 W RUTLAND RD <br /> (City,Slate,Zip) (City,State,Zip) <br /> BROOKLYN,WI 53521 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> drstace@gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0510-303-8510-0 TOWN OF RUTLAND 30 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address a 4733 W RUTLAND RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 10486 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PR ECT: Alter don to exisUn building CENSUS CODE <br /> RH-1 Rural Homes - 2.18 Description: 434-Residential Addition <br /> District 0 VC a i f I 0\ <br /> Category ® Residential ❑ Commercial ❑ Agricultural SE R x SANITARY PERMIT NO. <br /> ❑ Other: I I E 1 Y k$ .- <br /> ROAD CLASSIFICATION REZONE NO C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 8`/�/ <br /> ❑ YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES fa NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 250 <br /> 21 Sq.Ft. Sq.Ft.250 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $7,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $68.75 <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 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 TURE:0 / gent DATE: <br /> Ordinances.Any unauthorized change from the Information or o <br /> plans submitted will Invalidate the permit. 4r // 9 /d <br /> OFFICE USE ONLY (form version 04.00 00) <br /> SURVEY REQUIRED? DATE ISSUED TIALS 1st INSPECTION DATE INITIALS <br /> 03/19/2018 SCW1 <br /> ❑ YES R3 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 3 -r IS 1 j,/t■ <br /> f. <br />