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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPZP-2018-00155 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CHRISTOPHER GRIFFIN (608)235-5489 CLEARY BUILDING CORP. (608)379-0132 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3836 HOMMEN LN 190 PAOLI ST <br /> (City,State,Zip) (City,State,Zip) <br /> DEERFIELD, WI 53531 VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KAYLA.GRIFFIN1190 @GMAIL.COM TLEESER @CLEARYBUILDING.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0712-191-9320-6 TOWN OF DEERFIELD 19 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3836 HOMM EN LN <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> II METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 1 Description:64'X 42'RESIDENTIAL ACCESSORY BUILDING 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2057 ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO El YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 2688 <br /> 12 Sq.Ft. Sq.Ft.2688 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $40,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $251.60 <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 ordinan -. <br /> r <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT• - • • • -r/• ! - DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / 9" /4(H <br /> OFFICE USE ONLY (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/19/2018 PMK2 <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: L.,,illVfg 5 t• -• <br />