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DANE COUNTY ZONING PERMIT DCPZP 2015 00228 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> VILLAGE OF DEFOREST Gog ,csy(0,(plsi VERIZON WIRELESS (414) 588-6012 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 306 DEFOREST ST 544 E OGDEN RDSTE 700#305 <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 MILWAUKEE, WI 53202 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BAKERD @VI.DEFOREST.WI.US RMSI @INTACCESS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-093-8581-4 TOWN OF BURKE <br /> .26 / SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4209 ANDERSON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 07441 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> C-2 Commercial " C Description:Verizon Wireless new equipment shelter and antennae 329- Other <br /> District J <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other <br /> V I C. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> R - *Re 1616 2032 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 195.5 <br /> 11.5 Sq.Ft. Sq.Ft. 195.5 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $75,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $350.00 <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 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: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. .--\.--' 11 ?, ?-1 .!s <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 04/29/2015 SJ W 3 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 5- 1 - / 5 FMK <br />