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DANE COUNTY ZONING PERMIT DCPZP2015-00415 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS E LANGE (608) 592-5785 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> N2136 SHAMROCK RD <br /> (City,State,Zip) (City,State,Zip) <br /> LODI, WI 53555 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> endres.tom@tds.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0908-083-8000-1 TOWN OF DANE 8 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7517 LEE 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 40 Description: 328-Other Non-Residential <br /> District (oG t►'e✓I fil 14A.aaktc Stted <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: none <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <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 TOTAL SQUARE FEET <br /> 1080 <br /> 20 Sq.Ft. Sq.Ft. 1080 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $15,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE$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 <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 /> hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> urposes of determining compliance with the zoning ordinances. <br /> vner&Agent hereby agree to comply with all Dane County SIGNATUR • a wne /Agent DATE: <br /> finances.Any unauthorized change from the information or <br /> ns submitted will invalidate the permit. L J J <br /> / 6//R//5 <br /> OFFICE USE ONLY (form version 03.00.07) <br /> !VEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/12/2015 SSA1 <br /> ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> s: 'IL (SPIK 1:c:-S) <br />