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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DONING PERMIT N . <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KAREN E KESSENICH (608) 512-9803 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3969 DVORAK RD <br /> (City,State,Zip) (City,State,Zip) <br /> DEERFIELD, WI 53531 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KAREN @INLANDBOATWORKS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0712-183-9215-0 TOWN OF DEERFIELD 18 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is <br /> 3969 DVORAK RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13203 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> LC-1 Limited 2.1 Description:SHED FOR COMMERCIAL STORAGE 327 -Stores <br /> Commercial Dist <br /> SANITARY PERMIT NO. <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10326 2176 ❑ YES 0 NO <br /> SHOND FLOOD ZONE WETLAND EC/SW NO. <br /> YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 6890 <br /> 32.75 Sq.Ft.3570 Sq.Ft.2210 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $100,000.00 <br /> 2 sq.Ft. 1105 sq.Ft. PERMIT FEE$400.00 <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 IGNA URE: Owner/Agent a I ATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ��� 01 )? dot <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 01/12/2015 <br /> HJH3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECT ION DATE INITIALS <br /> / 1 <br />