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CANE COUNTY ZONING PERMIT DCPZP2015-10422 Payr' �{2 <br /> JrNER ^+ RV.T CN A EN°CCN kC TOR irruRh A T.,N <br /> OWNER NAME PHONE AGENT!CONTRACTOR NAME PHONE <br /> HOPE LUTHERAN CHURCH DARREN WENDRICKS (608)224-1147 <br /> BIWNG NG ADDRESS(Number.Street) ADDRESS(Number.Street) <br /> 3702 COUNTY HIGHWAY AB 4285 SEVERSON DR <br /> (City.State.Tip) (City.State.Zip) <br /> MCFARLAND,WI 53558 MADISON, WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DGWENDRICKS@MAD1SON.K12.WI.US <br /> SECTION 1/4 1/41/4 <br /> 0711-193-9200-1 TOWN OF COTTAGE GROVE 19 SW SW <br /> P R P E R S r a:D R E S S HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 3702 COUNTY HIGHWAY AB <br /> subject to geld verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Nast Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 6.9 Description:PERGOLA 328-Other Non-Residential <br /> District <br /> Category ❑ Residential 0 Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Other RELIGIOUS USE Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES 0 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 /> 165 <br /> 10 Sq.Ft. Sq.FL 165 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,500.00 <br /> 1 Sq.Ft. Sq.Ft PERMIT FEE <br /> $0.00 <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: <br /> Ordinances.Any unauthorized change from the Information or / <br /> plans submitted will Invalidate the permit. ctTtR.d.+lti 14.4444.A.:(-61,...- J/15 16 <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/15/2015 HJH3 <br /> 0 YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: OW <br />