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DANE COUNTY ZONING PERMIT DCPZP ERMITN202 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DOTTL JT REV TR,PETER J&MARY P Cc( )s 7 5 __ Morton Buildings CCD©$)s7'/. �(o�. <br /> BILLING ADDRESS(Number,Street) ` 6p®s ADDRESS(Number,Street) <br /> 5426 COUNTY HIGHWAY A II 2355 Chris-na-mar Road <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 Dogdeville, WI 53533 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-222-9502-9 TOWN OF OREGON 22 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5426 COUNTY HIGHWAY A <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-1 Ex Exclusive Ag ['' Descri lion: -7z'1c4t 3C,.V„,F1elLSE pR A <br /> District J �or,'c vl�v� r ��c v=...,(7 R.-,Iclo 9 <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER / SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> I <br /> B-County Highway O 0 Q r <br /> I J ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> w <br /> 28 Sq.Ft. Sq.FL82e & B O< <br /> `-mo PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $281,246.00 <br /> Sq.Ft. Sq.Ft. PERMIT FEE <br /> $50.00 <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 SI TURE• ner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or (°r✓) O � / <br /> plans submitted will invalidate the permit. ' <br /> OFFICE USE ONLY (form version 03.01.01) • <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/25/2017 R W L 1 <br /> ❑ YES ® NO DATE REVIEWED y INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials._ . K C / / .AY■ <br />