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DANE COUNTY ZONING PERMIT DCPZP 2015 00388 Pagel of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JASON A LARSON (608) 842-0513 <br /> BILLING ADDRESS(Number.Street) ADDRESS(Number,Street) <br /> 6712 WINDSOR RIDGE LN <br /> (City,State,Zip) (City,State,Zip) <br /> WINDSOR, WI 53598 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jklmno6 @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0910-293-0557-0 TOWN OF WINDSOR 29 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6712 WINDSOR RIDGE <br /> subject to field verification.) LN <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 6 WINDSOR RIDGE <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-2 Residence 0.344 Description. 11 x 4 x 8 tall chicken coop 329- Other <br /> District <br /> Category f Residential ❑ Commercial 0 Agricultural SEWER SANITARY PERMIT NO. <br /> ® Other:CHICKEN COOP Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES Ej NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 44 <br /> Sq.F1. Sq.Ft.44 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error <br /> 1 Sq.Ft. Sq.Ft PERMIT FEE <br /> $15.00 <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 /> wrww.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•., 0, fle�/Age DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will Invalidate the permit. �' "� f ,01..! r, I <br /> �f OFFICE GSE CNLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS .r t INSPECTION DATE INITIALS <br /> 06/08/2015 SJW3 <br /> As! YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials:iarli>• <br /> r <br />