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DANE COUNTY ZONING PERMIT ZONING <br /> 2021700393 Page 1of2 <br /> DCPZPOWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAMES A TJUGUM (608)843-9733 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1668 SPRING RD <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0611-344-8700-0 TOWN OF PLEASANT SPRINGS 34 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1668 SPRING RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 10722 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RR-4 Rural 4.70 Description:1440 sq ft storage shed 329- Other <br /> Residential District <br /> Category 0 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 /> C-Town Road ❑ 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 /> 1440 <br /> 19 Sq.Ft. Sq.Ft.1440 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $194.00 <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 S ` ' TU RE: Own-r/Agent DAT-. <br /> Ordinances.Any unauthorized change from the information or � <br /> plans submitted will invalidate the permit <br /> Ai' 12."- id" /� �`6 <br /> )- <br /> OFFICE LSE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED 'ITIALS 1st INSPECTION DATE INITIALS <br /> 07/08/2021 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: I-1*r <br />