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DANE COUNTY ZONING PERMIT ZONING PERMIT <br /> 0043 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MATTHEW ANDERSON (608) 335-3605 SCOTT FOLEY (608)825-4633 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7141 KALLAND WAY 4827 PIERCEVILLE RD <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BRETN)HAMMER @GMAIL.COM SAF @ULTIMATE-CONSTRUCTION.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-243-0120-0 TOWN OF BURKE 24 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 3313 NELSON RD <br /> subject to field verification.) <br /> I <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 15978 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RR-2 Rural 2.56 Description:SFR W/2 BEDROOMS&UNFINISHED BASEMENT 101 -SFR(detached) <br /> Residential District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other: Private 13-2022-00344 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES RI NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES II NO <br /> HEIGHT On Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6162 <br /> 26 sq.Ft.2456 sq.Ft.3706 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $750,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $666.20 <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 SIGN' U: : Owne '.ent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. �I `1 ` 4 -'4. ! 2-S <br /> OFFICE t:SE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS . INSPECTION DATE INITIALS <br /> 01/04/2023 SLJ3 <br /> ® Y S ❑ NO <br /> GATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />