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DANE COUNTY ZONING PERMIT DCPZP-2016-00504 Pagel of OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE ROBIN H MAROHN (608)220-7500 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 201 ISLAND DR (City,State,Zip) (City,State,Zip) MADISON, WI 53705 E-MAIL ADDRESS E-MAIL ADDRESS ppenn0402 @gmail.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0606-363-8625-0 TOWN OF BLUE MOUNDS 36 SW NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address Is 9736 BLUE VALLEY RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 2 CSM 13606 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE A-B Ag-Business 14.413 Description:restroom addn 328-Other Non-Residential District Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private 13-2016- ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road DCPREZ-2013-10548 DCPCUP-0000-02236 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES NO YES .41NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 14 Sq.Ft. Sq.Ft.276 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error 1 Sq.Ft. Sq.Ft. PERMIT FEE $100.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner a&es.Agent Any unauthorized horiz to comply with the all Dane County SIGNAT OW /A Ordinances.Any unauthorized change from th information or plans submitted will invalidate the permit. / % 9 C /4 OFFICE USE ONLY (form version 03.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 08/09/2016 RLB ES ® NO ' DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initial � .l , 8 - )0 - 16