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DANE COUNTY ZONING PERMIT DCPZP-2018-00133 Pagel oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JACOB A REPPEN (608)884-9319 Anderson Premier Homes (608)455-2525 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 432 ALBION RD W740 Amidon Rd., <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0512-271-8601-0 TOWN OF ALBION <br /> 27 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 444 Albion RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes 30.26 Description: 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private Sanitary District It provided <br /> ❑ Other. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 11223 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES o NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5004 <br /> 14 Sq.Ft.1752 Sq.Ft.3252 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $180,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $425.30 <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 SIG■ _ URE: Owner/Age t DATE: <br /> Ordinances.Any unauthorized change from the information or /r, _ i AV‘A plans submitted will invalidate the permit. ' <br /> ►4 y �. <br /> OFFICE USE ONI.f (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/11/2018 SC W 1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> II< ....Di 4, <br />