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Application Number:APP-38523 <br /> • <br /> ZONING PERMIT NO. <br /> • DANE COUNTY ZONING PERMIT Page 1 of 2 ZP20090660 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROSS BROWN (608)655-4965 SAME AS OWNER (608)220-9049 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 2430 COUNTY HIGHWAY BB <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 <br /> E-MAILADDRESS E-MAILADDRESS <br /> ROSS.BROWN @DATCP.STATE.WI.US <br /> PARCEL NO TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0812-264-8500-0 MEDINA 26 SE NW <br /> NO J('1 J 4;4 C/11 4*11111 HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject 5138 TOWER LINE RD <br /> to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS: METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New Addition/Alteration CENSUS CODE <br /> A-1 EX 40.7 CHANGE SFR TO AG ACC BLDG 328-OTHER NON-RES <br /> Description: <br /> CATEGORY ❑Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: ❑Public Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C ❑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 /> 28 1080 1704 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 1,000.00 <br /> 2 624 PERMIT FEE <br /> Sq.Ft. Sq.Ft. $ 178.00 <br /> 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 <br /> 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 <br /> 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 <br /> 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. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane Coun. <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit lt. ilr • 10_ _ ,. <br /> 4 <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPEC ON D INITI <br /> ❑Yes ❑No 14 Oct 2009 RLB L DATE REVIEWED INITIALS 2nd I� I�DAyE�/ INIT,JgLS� <br /> Initials: // e[//// ((�((���r1-< <br /> Conditions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE PROJECT <br /> REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND ID Y <br /> MODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING.INI <br /> 2. SURVEY ADVISORY NOTE: A LOCATION SURVEY MAY BE REQUIRED TO VERIFY THAT THE <br /> BUILDING IS CONSTRUCTED ACCORDING TO THE PLAN SUBMITTED WITH THIS APPLICATION. <br /> 5.45-112(12/05) GCS-multi <br />