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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page lof2 <br /> DCPZP-2015-00108 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRYAN E SORENSON (608) 957-6094 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 290 US HIGHWAY 14 <br /> (City,State,Zip) (City,State,Zip) p,k . <br /> BROOKLYN, WI 53521 �.Cl F .: <br /> E-MAIL ADDRESS E-MAIL ADDRESS 'I'' r ) <br /> . _ <br /> PARCEL NO. TOWNSHIP SECTION P �1(Q' <br /> 0510-293-9185-6 TOWN OF RUTLAND 29 SW P�P��4A.,c�O W <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 290 US HIGHVV�„Qa' I'4 <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 6 Description:Agriculture building for livestock 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO El YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR 'TOTAL SQUARE FEET <br /> 602 <br /> 10 Sq.Ft. Sq.Ft.602 . <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $6,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $0.00 <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 v• <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> ��p4. .0 � <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspeci•_; <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: OwnerlAgent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 414-- s , <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/18/2015 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: +pC 0 I P /�^_1 K <br />