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DANE COUNTY ZONING PERMIT ZONING PERMIT Page 1 of 2 <br /> 00230 <br /> OWNER INFORMATION <br /> AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME <br /> PAUL J DREIS (608) 795-4986 MEIGS INC. (608E <br /> (608) 767-2729 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5455 MAHOCKER RD P.O. BOX 412 <br /> (City,State,Zip) (City,State,Zip) <br /> MAZOMANIE, WI 53560 BLACK EARTH, WI 53515 <br /> E-MAIL ADDRESS <br /> PAUL.DREIS@STRAND.COM E-MAIL ADDRESS <br /> DAVE @MEIGSBUILDS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 <br /> 1/4 1/4 <br /> 0806-194-8170-8 TOWN OF BLACK EARTH 19 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME <br /> (Assignment of new address is 5455 ST.TYPE <br /> MAHOCKER <br /> subject to field verification.) RD <br /> LOT 'BLOCK I C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition <br /> A-1 Ex Exclusive Ag 13 Description:24'X 40'DETACHED GARAGE CENSUS CODE <br /> District 438-Garage <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. <br /> C-Town Road DEED RESTRICTION <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR <br /> TOTAL SQUARE FEET <br /> 14 Sq.Ft. Sq.Ft.960 960 <br /> PROJECT COST <br /> NO.OF STORIES <br /> 2nd FLOOR 3rd FLOOR $45,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $122.00 <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 premise •y Dane County zoning inspectors for the <br /> purposes of determining compliance with the zonin• .rd nances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN U- : Own <br /> Ordinances.Any unauthorized change from the information or DATE: <br /> plans submitted will invalidate the permit. / / 4/z9 r <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/29/2015 PMK2 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />