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• <br /> -DANE COUNTY ZONING PERMIT DCPZP-2015-00197 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> WI DNR NATURAL HERITAGE LAND TRUST (608)258-9797 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> PO BOX 7921 303 S PATERSON ST#6 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53701-7921 MADISON,WI 53703 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JIM @NHLT.ORG <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0911-334-9510-1 TOWN OF BRISTOL <br /> 33 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2375 STONE QUARRY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 53.9 Description:WILDLIFE VIEWING PLATFORM 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other:WILDLIFE VIEWING PLATFORM Septic <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 3667 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ❑ NO ❑ YES ® NO ® YES ❑ NO SE-2015-0099 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 320 <br /> 4 Sq.Ft. Sq.Ft.320 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $15,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $0.00 <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 /> 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: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/22/2015 HJH3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />