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page 1 of 2 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 1-oo4o2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAMEPi-4 <br /> PHONE AGENT/CONTRACTOR NAMEO\E <br /> PEGGY A GOCHNOUR (832) 764-9935 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3131 WOODS RD <br /> (City,State,Zip) (City,State.Zip) <br /> VERONA,WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PGOCHNOUR0115@GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1141/4 <br /> 4 NW SE <br /> 0608-042-9671-0 TOWN OF VERONA <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME Si TYPE <br /> (Assignment of new address is <br /> 3131 WOODS RD <br /> subject to field verification.) i <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 /> RR-2 Rural 5 Description DECK 329- Other <br /> Residential District <br /> Category a Residential ❑ Commercial ❑ Agncultura, SEWER SANITARY PERMIT NO <br /> Private <br /> 0 Other <br /> ROAD CLASSIFICATION REZONE NO C U.P.NO VARIANCE NO DEED RESTRICTION <br /> C-Town Road ❑ YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES *,7} NO ❑ YES Q NO O YES El NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 980 <br /> 2 Sq.Ft Sq =t 980 <br /> PROJECT COST <br /> - <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR S25,000.00 <br /> 1 Sq.Ft. S4.F', PERMIT FEES148.00 <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/ ntDATE: <br /> Ordinances.Any unauthorized change from the information or - �} J <br /> plans submitted will invalidate the permit. 1 ' . A.-s.-c:-.Z.,'1 l I t,�' — 1 'I <br /> • <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS J 1st INSPECTION DATE INII IALS <br /> 07/142021 PMK2 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />