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DANE COUNTY ZONING PERMIT DCPZP-2017-00231 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ZRH (608)781-8988 TED CONE (608) 793-5996 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1626 OAK ST 1626 OAK ST <br /> (City,State,Zip) (City,State,Zip) <br /> LACROSSE, WI 54603 LA CROSS, WI 54603-2107 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tcone @kwiktrip.com tcone @kwiktrip.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-292-8105-6 TOWN OF MIDDLETON 29 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7587 W MINERAL POINT RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 07415 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> C-1 Commercial 1.12 Description:walkin freezer 324-Offices <br /> District <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 4023 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 104 <br /> 8'-6" Sq.Ft. Sq.Ft. 104 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $40,000.00 <br /> 1 Sq,Ft. Sq.Ft. PERMIT FEE <br /> $280.00 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/04/2017 SSA1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />