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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 oft <br /> DCPZP-2015-00416 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DONALD J ELLICKSON (608)849-4141 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6581 HYSLOP RD <br /> (City,State,Zip) (City,State,Zip) <br /> DANE,WI 53529 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sayltiagoellickson @gmail.com <br /> • PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0908-351-8690-2 TOWN OF DANE 35 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 6581 HYSLOP 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 Description:30'x 30'x 18'det res gar 438-Garage <br /> District xv <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Othe Private <br /> r. <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES p' NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES 171 NO ❑ YES Vi NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 900 <br /> 18 Sq.Ft. Sq.Ft.900 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $10,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $117.50 <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 /> • <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 or... . •-s, <br /> Owner&Agent hereby agree to comply wlth,all Dafe County SIGNA d' j� 7 gent DATE: <br /> Ordinances.Any unauthorized change from the information or ' ' .a -7 r <br /> plans submitted will invalidate the permit. �`�,r G.5 5 <br /> OFFICE USE ONLY (form ye.sion 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIAL- <br /> 06/12/2015 RLB <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials` �Cd!(� - `6 <br />