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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPZP-2021-00161 <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME 4 PHONE <br /> ABIGAIL P GASPARI (936)647-5505 <br /> BILLING ADDRESS(Number.Street) ADDRESS(Number.Street) <br /> 318 MAPLE HEIGHTS RD <br /> (Cly,State,Zip) (City,State,Zip) <br /> MARSHALL,WI 53559 <br /> EMAIL ADDRESS E-MAIL ADDRESS <br /> GAS PAR IAB I GAI L@ GMAIL.COM <br /> SECTION 1/4 1/41/4 <br /> 0812-111-6316-2 TOWN OF MEDINA <br /> 11 NE SE <br /> HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address la 318 MAPLE HEIGHTS RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 26 MAPLE HEIGHTS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Stmcture/Addllon CENSUS CODE <br /> SFR-08 Single 0.742 Description:DOMESTIC FOWL ENCLOSURE 6'X 8' 329-Other <br /> Family Residential <br /> Category 0 Residential 0 Commercial 0 Agdcufural SEWER SANITARY PERMIT NO. <br /> 0 Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-AOI Other <br /> ❑ YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 0 NO ❑ YES 0 NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 48 <br /> 4 5q.FL sq.R.48 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> 1 Sg.R. So.FL PERMIT FEE <br /> $10.00 <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 8 Agent hereby agree to comply with all Dane County SIGNATURE:0 j DATE: <br /> Ordinances.Any unauthorized change from the information or April 2 2021 <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONL'r (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS pr 1st INSPECTION DATE INITIALS <br /> 04/022021 <br /> 0 YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />