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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THEODORE J FRIEDL (608) 212._9Q667- <br /> r <br /> BILLING ADDRESS(Number,Street) `C'` ` 7 ADDRESS(Number,Street) <br /> 4746 COUNTY HIGHWAY A <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 <br /> E-MAIL O).ADDRESS R r E EDI- @ G M P I L •(` (5'/1/f <br /> E-MAIL ADDRESS <br /> T <br /> 1 PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-241-8325-3 TOWN OF OREGON 24 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4746 COUNTY HIGHWAY A <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 1 CSM 06286 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 8.1 Description:RUN-IN BUILDING 10 X 20 328-Other Non-Residential <br /> District <br /> Category El Residential 0 Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> p Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 6123 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> fl YES ® NO 0 YES ® NO 0 YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 200 <br /> 10 Sq.Ft. Sq.Ft.200 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $3,755.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $65.00 <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 <br /> subject 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 <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at 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• RE:-wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or � / <br /> plans submitted will invalidate the permit. -. L` 6 <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/14/2016 HJH3 <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: ? 7 " IS - l CD P iY <br />