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DANE COUNTY ZONING PERMIT DCPZP-20 500788 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MICHAEL P SCHLOBOHM (608)764-8101 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3759 ROBERT NELSON RD <br /> (City,State,Zip) (City,State,Zip) <br /> DEERFIELD,WI 53531 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mlaplant1@frontier.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0712-213-8860-8 TOWN OF DEERFIELD 21 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3759 ROBERT NELSON RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 01180 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> LC-1 Limited Description:30'x 24'x 15'att res gar addn,10.25(am)DCCO 438-Garage <br /> Commercial Dist <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 6503 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO 0 YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 720 <br /> 15 Sq.Ft. Sq.Ft.720 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $8,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $104.00 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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/' • • t I DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. r <br /> 41b. <br /> OFF ICE USE ONLY (form v':rsion 33.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/29/2015 RLB <br /> ❑ YES ® .NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initia A,,‘... <br />