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DANE COUNTY ZONING PERMIT DQNPNS3PER�AITN0043-:3s ` „, <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION ` *: :°.k. ' <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MARK S ROSENBAUM (608)873-5068 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 972 STATE HIGHWAY 138 <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41x.; <br /> 0511-181-9510-4 TOWN OF DUNKIRK 18 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME I I. <br /> (Assignment of new address is 971 STATE HIGHWAY 138 <br /> subject to field verification.) <br /> LOT C.S.M.NO.or PLAT NAME <br /> 1 1BLOCK <br /> CSM 05895 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-2 Rural Homes Description:storage shed 70'x52' 438- Garage <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED i.ESI RIC1ION <br /> A-US or State Highway 4441 <br /> ❑ "ta . , <br /> SHORELAND FLOOD ZONE WEI LAND EC/SW NO <br /> ❑ YES p NO ❑ YES ® NO L YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR 101AL SQUARE FEEI <br /> 27 Sq.Ft. Sq.Ft.3640 <br /> 3640 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $70,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $323.00 <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 voi:J anc' s.;bj,/c11 <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: 0 • nerl-• , it DA'E: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. �� 11 //h----- <br /> OFFICE USE ONLY ,! (tgrm y�er .r O 1 41 <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DAIE INITIALS <br /> 04/01/2015 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 2 <br />