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DANE COUNTY ZONING PERMIT DCPZP 2015-00004 Page 1 of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MARK W HUSTON (608)332-6719 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3866 VILAS RD <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE,WI 53527 <br /> RECF1VED <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION i EB 11/43 21 t 1/41/4 <br /> 0711-212-9130-0 TOWN OF COTTAGE GROVE 21 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME TYPE <br /> (Assignment of new address is 3866 DANE 0 *Ith 9d PLANNING&DEVELOPN TT RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 09702 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes Description:40'x 26'x 15'fabric hay stor shed 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> El otner: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 7791 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES U NO ❑ YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1040 <br /> 15 Sq.Ft. Sq.Ft.1040 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $100.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $128.00 <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 URE: Owner/A•ent <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ■ / / ' _„ ■ 1 —3 J_I <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 01/06/2015 RLB <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: iv <br />