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DANE COUNTY ZONING PERMIT DCPZGPERMI-00011 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANE COUNTY LAND INVESTMENTS LLC (608) 217-5558 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1357 DIANE AVE <br /> (City,State,Zip) (City,State,Zip) <br /> BELLEVILLE, WI 53508 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jonjaeck @yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-211-8691-0 TOWN OF PLEASANT SPRINGS 21 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2479 GLENN DR <br /> subject to field verification.) <br /> LOT . BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 (1)Agriculture Description:ground on-premise 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other:Ground Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES @ NO ❑ YES ® NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 40 <br /> 8 Sq.Ft. Sq.Ft.40 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $900.00 <br /> Sq.Ft. Sq.Ft PERMIT FEE <br /> t. <br /> $100.00 <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 SIG URE: Owner/Age� DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. rA� rc/ OOP <br /> OFFICE USE ONLY (form v<rsion 03.01.00) <br /> goy <br /> SURVEY REQUIRED 7 DATE ISSUED 177LS 1st INSPECTION DATE INITIALS <br /> 01/30/2017 SCW1 <br /> ® YES ❑ NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br /> "19 <br />