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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2015-00610 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN C SCHELLER (608) 873-4524 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1102 LAKE KEGONSA RD <br /> (City.State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JOS_1999©YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0510-114-9110-0 TOWN OF RUTLAND <br /> 11 SE SW <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1102 LAKE KEGONSA RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 11846 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 10 Description:24'X 40'POLE SHED 329 - Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> El otner Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED RESTRICTION <br /> C-Town Road 9485 <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 /> 960 <br /> 13 Sq.Ft. Sq.Ft.960 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $14,300.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $122.00 <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 pOormed, 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 his permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for co Tying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. W tlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may re ult in removal or modification of construction that violates <br /> the law or other penalties or costs. For mor information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the epartment 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 SIGNA-TURE: Owner/Agent DATE <br /> Ordinances.Any unauthorized change from the information or ( �'/ <br /> plans submitted will invalidate the permit. - <br /> OFFICE USE :iILY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED • r'TI• S 1st INSPECTION DATE INITIALS <br /> 08/10/2015 <br /> it® Y ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />