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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2021-00506 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GIDEON AMOAH (312) 731-6722 STEVE MEIER (608) 469-7889 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 513 POWERS AVE 575 DONOFRIO DR SUITE 101 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53714 MADISON, WI 53719 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> GIDAMOAH@HOTMAIL.COM STEVE@MEIERC.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0710-051-3160-5 TOWN OF BLOOMING GROVE <br /> 5 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 513 POWERS AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 11 GALLAGHER, ELISHA L 2ND ADD REPLAT OF BLKS 11,12,13,15,16& PT BLK 14 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> SFR-08 Single 0.12 Description:ADDN TO EXISTING BEDROOM AND ADDN TO 434- Residential Addition <br /> Family Residential EXISTING DECK <br /> Category Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D-Unadopted Subdiv <br /> Streets ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO ❑ YES ® NO ❑ YES I NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 143 <br /> 16.3 Sq.Ft. Sq.Ft.143 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $59,200.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $64.30 <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.usor 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 <br /> plans submitted will invalidate the permit. 8/31/21 <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/31/2021 SLJ3 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: SM <br />