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Ap•Iication Number:APP-34744 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090297 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RURAL MASONRY CO INC (847)706-1745 CONCORDIA WIRELESS (414)403-3103 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> PO BOX 7156 505 EAST GOLF RD SUITE D&E <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53707 ARLINGTON HEIGHTS, IL 60005 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SHARON.ORPS @VERIZONWIRELESS.COM LBERA @CONCORDIAWIRELESS.COM <br /> PARCEL NO. I TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-243-8730-1 BURKE 24 SW NW <br /> -,:l•l:i 4:Y IV/:.1 el'1;I 4S1/1 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 5458 REINER RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS: METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New 141 Addition/Alteration CENSUS CODE <br /> C-2 7.5 Description:COLOCATION OF ANTENNA ON CELL TOWER 329 - OTHER <br /> CATEGORY ❑Residential g Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other.COLOCATION OF ANTENNA ON CELL TOWER ❑Public <br /> Private NA <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C 1813 ❑Yes ❑No <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑Yes X No El Yes X No ❑Yes $)No NA <br /> HEIGHT(In Feet) BASEMENT "ht FLOOR TOTAL SQUARE FEET <br /> 100 0 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR Ord FLOOR $ 35J 000.00 <br /> PERMIT FEE <br /> 0 Sq.Ft. Sq.Ft. $ 270.00 <br /> 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 <br /> 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 <br /> 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 <br /> 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. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances. This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIG NAT RE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information 1 <br /> or plans submitted will invalidate the permit /�p¢/ 9c.6 v//1/47 <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑Yes XI No 10 Jun 2009 HJH3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE <br /> Conditions. PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF ANY IFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. <br /> INITIALS <br /> 545-112(12/05) GCS-single <br />