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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP-2016-00508 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GROWMARK INC (608) 767-2172 GROWMARK INC (608) 767-2172 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> PO BOX 359 PO BOX 359 <br /> (City,State,Zip) (City,State,Zip) <br /> JEFFERSON, WI 53549 JEFFERSON, WI 53549 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0807-082-9500-9 TOWN OF BERRY 8 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9119 STATE HIGHWAY 19 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 02370 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> A-B Ag-Business 3.791 Description:SHED ADDN WITH 2 SIDES,OPEN ON SOUTHERN 328-Other Non-Residential <br /> District END(NO CHANGE OF GRADE)(STROAGE YARD) <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 1873 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ® YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 552 <br /> 13 Sq.Ft. Sq.Ft.552 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $3,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $206.00 <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•TURE: 0 ner/Age t DATE: <br /> Ordinances.Any unauthorized change from the information or l /C,/� <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/10/2016 HJH3 <br /> ❑ YES ® NO DATE REVIEWED t INITIALS ` 2nd INSPECTION DATE INITIALS <br /> 1 e `l <br /> Initials: 1��� <br />