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DANE COUNTY ZONING PERMIT DCPZP-2015 00118 Page lof2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE ' <br /> KIM HANSEN (608) 576-6821 RUTHANN HANSEN 63566" - -- <br /> �, - I <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 706 BOWERS RD 706 BOWRS RD <br /> (City,State,Zip) (City,State,Zip) <br /> BELLEVILLE, WI 53508 BELLEVILLE, WI 53508 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rhansen @chorus.net rhansen @chorus.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0507-224,6490-0. els.5 -0 TOWN OF PRIMROSE 22 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 706 BOWERS RD 1 <br /> subject to field verification.) <br /> LOT i 1 BLOCK C.S.M.NO.or PLAT NAME <br /> CSM 12979 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> -A 477668, Description:chicken coop 329-Other <br /> VI. I District O <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> El Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10215 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WET EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO D YES i NO <br /> - <br /> HEIGHT(In Feet) BASEMENT c 1st FLOOR TOTAL SQUARE FEET <br /> 328 <br /> 12'-0" Sq.Ft. Sq.Ft.328 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,100.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $74.60 <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 SIGNA - : Owner1A nt DATE:,� �,,.- <br /> Ordinances.Any unauthorized change from the information or �/� , ���"r/` 1/Xt-GL��(5�w<J <br /> plans submitted will invalidate the permit. rat <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/24/2015 SSA1 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 3 ^•a 6 /5 P (All, <br /> 1 <br />