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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> DCPZP-2021-00313 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME D.=0t,1= <br /> RADMW TR (641)583-2923 1 <br /> BILLING ADDRESS(Number.Street) ADDRESS(Number,Street) <br /> 1141 S STATE STREET RD <br /> (City,State.Zip) (City.State,Zip) <br /> MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MAEWILLITS@GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1.'4 1/4 1?4 <br /> 0506-083-5101-7 TOWN OF PERRY 8 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1141 STATE HIGHWAY 78 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 2 GOLI ADDITION <br /> ZONING DISTRICT !PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> HAM-R Hamlet .265 DPscrint,nn-DECK 329 - Other <br /> Residential District ! , <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> [2 Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.R NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 9 NO ❑ YES 0 NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 210 <br /> 2 Sq.Ft. Sq.Ft.210 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $4,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $71.00 <br /> 1, 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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or e <br /> plans submitted will invalidate the permit. /-�( �� 6 --9.-- 2/ <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/07/2021 PMK2 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials}.,0&•L-(// <br />