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. 2 .1',c•� ��=+ "- n' +( �^"'fj ge,1�V f^ hp Ill;dluuul IVUIIIUCI. r1rr--000;y+ DANE COITI■ TY ZONING PERMIT ZONING PERMIT NO. ZP20090666 OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE LARRY D JACOBSON LLC (920)648-3993 STUBBLEFIELD&SONSSSS LLC (920)648-3993 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 6368 BRANDYWOOD TRL 534 W LAKE PARK PLACE (City,State,Zip) (City,State,Zip) SUN PRAIRIE, WI 53590 LAKE MILLS, WI 53551 E-MAIL ADDRESS E-MAIL ADDRESS BART @STUBBLEFIELDSIGNS.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0810-032-1613-0 BURKE 03 NW NE MI J[.114 a rV/_l'l'];l*11/11 HOUSE NO. ST.DIRECTION STREET NAME ST TYPE (Assignment of new address is subject to field verification.) 3827 P ED E RSON DR LOT BLOCK C.S.M.NO.Qr PLAT NAME 2 CERTIFIED SURVEY MAP: CSM 09638 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New lid Addition/Alteration CENSUS CODE B-1 2.4 Description:RETROFIT LED PRICE CHANGERS IN EXISTING SIGN 329 - OTHER CATEGORY ❑Residential A Commercial LI Agricultural SEWER SANITARY PERMIT NO. ❑other: ❑Public I Private NA ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION A ❑Yes 0 N SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑Yes X No CI Yes Yes X]I No ❑Yes X No NA HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 15.5 85.25 85.25 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR 40 10,000.00 PERMIT FEE 0 Sq.Ft. Sq.Ft. 100.00 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. 2. I,the undersigned, hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compliance with the county's zoning ordinances. This consent is valid for the period Comm-icing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until ei ier revoked in writing Are owner of the pr.perty —.AssrAIIIIIII. Owner&Agent hereby agree to comply with all Dane County ' - • - • ;!A,ent /M' I.ATE: Ordinances.Any unauthorized change from the information / or plans submitted will invalidate the permit '`� �, /,� �� /1/ / .1�/ OFFICE USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPE'TION DATE INITIALS ❑Yes !! No 15 Oct 2009 HJH3 0 DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: 0 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO TH • •1 T Conditions: REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND V. •Q!: I M99lFIC TIONS�ARE M22DE ITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING.INITIALS �&.„ f /ai-'/f 1— NO 590--- 545-112(12/05) GCS-single