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07-21-15; 11 :43AM; 2671540 ; # 6/ 7 <br /> v• ' L I. G V I d I I • v Th.,. <br /> Iru. ui[p 1. L <br /> DANE COUNTY ZONING PERMIT o0WING zo 6 00650 Page 1 of 2 <br /> OWNER INFORMATION I AGENT/CONTRACTOR ItaFQfiMAI ION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PATRONS MERCANTIL.a COOPERATIVE (808)431-5536 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> PO BOX 230 . <br /> (City,State,zip) (City.Stale,Zip) <br /> MT HOREB, WI 53572 • <br /> ' E-MAIL ADDRESS E•MAILADDRESS <br /> SECTION 1/4 110111 <br /> 0806-154-9280-1 TOWN OF MAZOMANIE 15 I SE SW <br /> PRQP:.RT'r'ACUI:LSN MOUSE NO. ST.DIRECTION STREET NAME ST.TYPt? <br /> (/larlgnment or new address is 10216 US HIGHWAY 14 <br /> subject to field vemloauon.) <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 /> C-2 Commercial 5 Description:electrical room/bldg 328-Other Non-Residential <br /> District <br /> empty ❑ Residential 0 Commercial ❑ AgdcUltufpl SEWER SANITARY PERMIT NO. <br /> ❑ Mar <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or Stale Highway 1329 ❑ YEs ® NO <br /> SMORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO Q YES PI NO '❑ YES la NO <br /> ec2015-0194/swm2015-0195 <br /> HEIGHT(In Feel) BASEMENT 1m FLOOR /00 TOTAL SCUARE FEET /Q© <br /> .�r R.. eq.Ft. Sq.Flaw- <br /> PROJECT COST Z <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> 1 Sq.fl. Sq.FL PERMIT FEE <br /> $200.00 <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.wl.lr 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 b Agent hereby spree to comply With alit Dane County $ T :f/*wneN' r _ a ATE: <br /> Ordinances.Any unauthorized change from the Information or '' <br /> plans submitted will Invalidate the permit, ir , // a.j I A. <br /> UI I ILL USL ONLY (form version 03.00,07) <br /> SURVEY REQUIRED T DATE ISSUED INITIAL•/ let INSPECTION DATE INITIALS <br /> ❑ rrrs ® NO o7/21/201e SCW1 <br /> DATE REVIEW INITIALS 2nd INSPECTION DATE INITIALS <br />