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. A Ap•Iication Number:APP-35009 DANE COUNTY ZONING PERMIT ZONING PERMIT NO. ZP20090330 OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE MICHAEL SUCHOMEL (847)226-5533 CONCORDIA WIRELESS (414)403-3103 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 6207 BARMAN RD 505 EAST GOLF RD SUITE D&E (City.State,Zip) (City,State,Zip) WAUNAKEE,WI 53597 ARLINGTON HEIGHTS, IL 60005 E-MAIL ADDRESS E-MAI L ADDRESS SCOTT.STASTNY @AMERICANTOWER.COM LBERA @CONCORDIAWIRELESS.COM PARCEL NO TOWNSHIP SECTION 1/4 1/4 1/4 0808-033-8400-9 SPRINGFIELD 03 SW NE IMI I asl I/141 C/1111 D1:1 4:11111 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is subject to field verification.) 6207 BARMAN RD LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS: METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New Addition/Alteration CENSUS CODE A-2(1) 2.25 Description:ATTACH ANTENNA TO EXISTING CELL TOWER 328-OTHER NON-RES CATEGORY ❑Residential 10!Commercial ❑Agricultural SEWER SANITARY PERMIT NO. ❑Other:ATTACH ANTENNA TO EXISTING CELL TOWER ❑Public Private NA ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C 1018 ❑Yes ❑No SHORELAND FLOOD ZONE �1 WETLAND EC/SW NO. Oyes Xl No ❑Yes ,�No ❑Yes X No NA HEIGHT(In Feet) BASEMENT Itt FLOOR TOTAL SQUARE FEET 0 200 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 35,000.00 PERMIT FEE 0 Sq.Ft. Sq.Ft. $ 270.00 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. 2. I,the undersigned,hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. Owner 8,Agent hereby agree to comply with all Dane County NATURI: Owner/Agent E: Ordinances.Any unauthorized change from the information ��" or plans submitted will invalidate the permit ice', . •/ t,> . i:r . Irl OFFICE. USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS ❑Yes A No 22 Jun 2009 HJH3 1-17X--- DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS 1. OAS PRESENTED. MODIFICATIO TO Conditions. PROJECT THIS REQUIRES APPROVAL BY THE DANE EXPRESS COUNTY WRITTEN Z NING APPROVAL IS ONLY FOR BY THE DANE PL COUNTY ZONING. THIS ANY PERMIT SHALL N BE NULL THE AND VOID NY�IONS RE MADE WITHO T THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. WITHO 0a Z 545-112(12/05) GCS-single