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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2015-00545 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LAMBERTY SURVIVOR'S TR,MICHAEL R (608)798-3588 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 8614 BAKKEN RD <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB,WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PAFCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0607-033-9500-2 TOWN OF SPRINGDALE 3 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 8614 BAKKEN 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: Alteration to existing building CENSUS CODE <br /> A-1 Agriculture 40.4 Description:40'x 40'addn to exst machine shed 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <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 lY NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1600 <br /> 25 Sq.Ft. Sq.Ft.1600 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $25,000.00 <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 wits 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.stpte.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby coisent 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 he'eby agree to comply with all Dane County SIGNATUR : 0 er/A. -nt DATE: <br /> Ordinances.Any upauthorized change from the information • / <br /> plans submitted w II invalidate the permit. ,1-, /, Ar Ae,- , - U- 2 '/' <br /> OFFICE USE ONLY (corm version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> YES ® NO 07/20/2015 RLB <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initia .. f t ? a ^ / P I K <br />