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ZONING PERMIT NO. <br /> DANE COUNTY ZONING PERMIT DCPZP-2021-00424 Pagel oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KEITH G FREDERICKSON (608)358-5755 ORLANDO RODRIGUEZ (608)572-1568 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5865 POND RD 1510 W MAIN ST#303 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53718 SUN PRAIRIE,WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LAF911 @YAHOO.COM RODRIGUEZEXTERIORSLLC@YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4114 <br /> 0810-104-4222-2 TOWN OF BURKE 10 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST,DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5865 POND RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 12 LOTHE WOODS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> SFR-08 Single 0.468 Description:DECK ADDN 8'X12',NO STEPS 434-Residential Addition <br /> Family Residential <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 /> E-AII Other <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES ® NO ❑ YES I•LJ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 96 <br /> 9 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $7,800.00 <br /> 1 sq.Ft 96 Sq.Ft. PERMIT FEE <br /> $59.60 <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 ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent ip DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. —��1L if 7 2„3/2a/ <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/23/2021 SLJ3 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />