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DANE COUNTY ZONING PERMIT DCPZP 2015-00739 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE DOOR LLC (G(;4 -<43 • Andy Mlsna 6 Q4 -- a,a -0?so <br /> BILLING ADDRESS(Number,Street) (18 go ADDRESS(Number,Street) <br /> 1523 STATE HIGHWAY 78 / 1523 State Road 78 <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 Mt. Horeb, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-221-8085-0 TOWN OF BLUE MOUNDS 22 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10043 Blessingway RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 10980 <br /> ZONING DISTRICT PARCEL ACREA E PROPOSED PROJECT: CENSUS CODE <br /> C-2 Commercial Description:40'x160'miniwarehouse,40'x155'miniwarehouse,two 328-Other Non-Residential <br /> District -,- 3 buildings <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road ?III ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES j NO ❑ YES ® NO ❑ YES ® NO CD O <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR p a o O TOTAL SQUARE FEET <br /> �0 12600 <br /> 10 Sq.Ft. Sq.Ft. 12600 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $200,000.00 <br /> Sq.Ft. Sq.Ft. PERMIT FEE <br /> $600.00 <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 SIGNATURE: Owner/Ag: `/ DATE: <br /> Ordinances.Any unauthorized change from the information or / ( <br /> plans submitted will invalidate the permit. t: ! -"O -IS <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/16/2015 R W L 1 <br /> ❑ YES o NO DATE(R�EVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 9 -/G, - /,� P,10 c <br />