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DANE 4 O U N TY ZONING PERMIT DCPZP-2015-00582 Page l of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> WI DOT TOWN OF SPRINGFIELD (608)849-7887 <br /> BILLING ADDRESS( umber,Street) ADDRESS(Number,Street) <br /> 2101 WRIGHT -T 6157 COUNTY HIGHWAY P <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI .3704 DANE, WI 53529 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TOWNHALL @TOWN.SPRINGFIELD.WI.US <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0808-05 -9795-6 TOWN OF SPRINGFIELD 5 SE SE <br /> PROPERTY AD DRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new ddress is 6130 US HIGHWAY 12 <br /> subject to field vertfl.atlon.) <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 /> CO-1 Conserv.ncy 0.85 Description:20x24 park shelter 329- Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ® I er:MUNICIPAL BUILDING <br /> ROAD CLASSIFICATI"N REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Hi• -y 10733 <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 /> 480 <br /> 14 Sq.Ft. Sq.Ft.480 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> Sq.Ft. Sq.Ft. PERMIT FEE <br /> $0.00 <br /> I, the undersir!ned, 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 .ubmitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply wit any provision or condition of this permit renders this zoning permit null and void and subject <br /> to enforceme t action. <br /> I acknowledg . that I am responsible for complying with State and Federal laws concerning construction <br /> near or on w: lands, lakes, and streams. Wetlands that are not associated with open water can be difficult <br /> to identify. F.ilure to comply may result in removal or modification of construction that violates the law or <br /> other penaltie. or costs. For more information, visit the Department of Natural Resources web page at <br /> www.dnr.stat: .wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby cons-nt to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of d-termining compliance with the zoning ordinances. <br /> Owner&Agent her by agree to comply with all Dane County SI NATU E• Ow = DATE• <br /> Ordinances.Any u authorized change from the Information or I f plans submitted wi invalidate the permit. D •I / U ! _/✓ <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/29/2015 SJW3 <br /> 0 Y ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br /> 1.,() <br />