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DANE COUNTY ZONING PERMIT DCPZP 2015 00217 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JACOBS COOPERAGE LLC (608)268-4777 LACROSSE SIGN COMPANY (608)222-5353 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6204 S HIGHLANDS AVE 2242 MUSTANG WAY <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53705 MADISON, WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TERESAK @LACROSSESIGN.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0709-354-9810-3 TOWN OF MADISON 35 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 2740 SKI LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 00780 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> C-2 Commercial 0.954 Description:replacement wall sign 30x3 face area 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> XOther.WALL SIGN Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES fa NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 70 <br /> 21 Sq.Ft. Sq.Ft.70 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $3,800.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $100.00 <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 SIGNATURE: Owner/Agent DATE J <br /> Ordinances.Any unauthorized change from the information or ��~+�.+�,,...,,-+ f <br /> Teresa Kiehl �.,,,1�{a,.s,�#,,,�. , ,�.,,,.,, cp <0.2 / — <br /> plans plans submitted will Invalidate the permit. Dot 70,34.N0711/14$0 <br /> . ,K...+�I,�,,.:,,�., <br /> P,v. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/27/2015 SJW3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: �'[)L, <br />