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DANE COUNTY ZONING PERMIT DCPZP-2015-00343 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DENNIS P SCHLIMGEN (608)437-8074 JL3 CONSULTING LLC (608) 215-3200 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2792 CAVE OF THE MOUNDS RD 1350 COUNTY HIGHWAY JG <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 MOUNT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LSCHLIMGEN @MHTC.NET JL3CONSULTING71 @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0606-084-8561-2 TOWN OF BLUE MOUNDS 8 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2792 CAVE OF THE MOUNDS RD <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 38.3 Description:OFFICE ADDITION AND REPLACEMENT PORCHES. 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road YES IO NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 643 <br /> 17 Sq.Ft. Sq.Ft.643 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $98.23 <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 SIGNATU- : O n- Agent DATE: <br /> Ordinances.Any unauthorized change from the information or inu <br /> plans submitted will invalidate the permit. � e//5 <br /> OFFICE USE C'NLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/28/2015 PMK2 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: ' <br />