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DANE COUNTY ZONING PERMIT ZONING PEF■Mi NO "c°1 °`` <br /> DCPZP-2015-00032 <br /> OWNER INI ORMATION r'AOEN1/CONTRACTOR WA-OW/Al ION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MADISON METROPOLITAN SEWERAGE (608)222-1201 JF AHERN CO (920)921-5517 <br /> rncTPtt'T <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 523 E MAIN ST 855 MORRIS STREET <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53703 FOND DU LAC,WI 54935 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HHOREJS@JFAHERN.COM <br /> SECTION 1/4 1141/4 <br /> 0710-313-8600-5 TOWN OF BLOOMING GROVE 31 SW NW <br /> 'F 01 T Y A[;D'1 SS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4760 E CLAYTON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT P RCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> A-2(2)Agriculture Description:pump station 11 addition 325-Public Works <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other UTILITY BUILDING <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10732 a YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ❑ NO 0 YES ❑ NO 0 YES ❑ NQ <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 14 Sq.Ft. Sq.Ft.280 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $309.20 <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 /> d <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA_ •,, 9 t DA =" <br /> Ordinances.Any unauthorized change from the information or /mg,plans submitted will invalidate the permit. �` I �2 L 1 <br /> 0,1 KL list_ CNt_Y (form.,i«.∎s oo O■ CO'171 <br /> SURVEY REQUIRED/ DATE ISSUED INITIALS let INSPECTION DATE INmALS <br /> 0 NO 01/26/2015 SJW3 <br /> YES <br /> t DATE VIEWED INITIALSA 2nd INSPECTION DATE INITIALS <br /> I I iC)"Ciii <br />