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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY ZONING PERMIT DCPZP-2021-00445 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PATRICK JENNISON (608) 373-4458 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 100 W LIMESTONE PASS#103 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53714 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PATRICK.JENNISON@GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1141/4 <br /> 0711-213-7100-0 TOWN OF COTTAGE GROVE <br /> 21 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2531 BASS RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 10 VINEYS ADDN TO SKYHIGH <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> SFR-08 Single 0.5 Description:4 BEDROOM SFR W/DECK 101 -SFR(detached) <br /> Family Residential <br /> Category Ci Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13-2021-00185 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> YES p NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES Q NO ❑ YES 0 NO ❑ YES El NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5320 <br /> 22 Sq.Ft.2008 Sq.Ft 3312 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $445,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $582.00 <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 /> =,u _. , w a iF: =} , 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 NATO !•wnerh. • t DAT <br /> Ordinances.Any unauthorized change from the information or / DOS` <br /> plans submitted will invalidate the permit. / �- - <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/04/2021 SLJ3 <br /> YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />