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DANE COUNTY ZONING ' ERMIT DCPZGPERMI-00671 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANIEL V NOLTNER (608) 836 1264 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7105 COUNTY HIGHWAY K <br /> (City,State,Zip) (City,State,Zip) <br /> MIDDLETON, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0808-273-8590-0 TOWN OF '.PRINGFIELD 27 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTI•N STREET NAME ST.TYPE <br /> (Assignment of new address is 7105 COUNTY HIGHWAY K <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M. 0.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSE')PROJECT: Alteration to existing building CENSUS CODE <br /> B-1 Local Business 0.38 Description:replace roof trusses 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Aericultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.N'. / VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLA D EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ ES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 15'8" Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $22,000.00 <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $100.00 <br /> I, the undersigned, am the owner of the pro•-rty or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be pe ormed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply wi lh the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of i is permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for com•lying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wz 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 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 permitte• premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with th. zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SI NATURE: Owner/Agen DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / t 1P � _ �. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 08/26/2015 SJ W 3 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: � 1" 8 -0 -15 P/9 K <br />