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DANE COUNTY ZONING PERMIT DCPZP 2015-00578 Page 1 of 2 <br /> OWNER INFORMATION ! AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANE COUNTY (608) 267-0119 Badger Prairie Needs Network (608) 848-2499 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 210 MARTIN LUTHER KING JR BLVD RM 114 1200 E Verona Ave., <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53703-3342 Verona, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> nebel @countyofdane.com mk @kasieth.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0608-142-9502-0 TOWN OF VERONA 14 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1200 E VERONA AVE <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-3 Agriculture 27.9 Description:ground on-premise Maple Grove Road access 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ® Other:ground sign Public <br /> ROAD CLASSIFICATION JJ __ REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> U S 0.t....5 I <br /> 1T� W'1( 10713 .3?a 9 �s d Q ❑ 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 /> r rl <br /> l � <br /> Sq.Ft. Sq.Ft.8 <br /> PROJECT COST 8 <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $4,000.00 <br /> 0 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 <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 /> 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 SIG ATURE: Owner/Agent /nom DATE:Any unauthorized change r from the information or /GtQ���L' 4 ( . "�- O�Y ���,/fir <br /> plans.submitted will invalidate the permit. �/� ��- %`-"�11 <br /> Vi <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> • YE ® NO INITIALS 2nd INSPECTION DATE INITIALS <br /> 07/29/2015 SCW1 <br /> DATE REVIEWED <br /> Initials: ■. k`0 S ,� , /. V <br /> 1 <br /> V r , <br />