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. j <br /> Ap•lication Number:APP-38535 <br /> - DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090662 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GEORGE WALSH (608)825-2949 SAME AS OWNER (608)778-6011 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 5375 BROKEN BOW RD <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE,WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BBTS @CHARTER.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-241-7242-6 BURKE 24 NE SE <br /> NJ:t•1»:iI1 r]r74* 1111HOUSENO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 5375 BROKEN BOW RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 22 PLAT: OAK RIDGE PARK- <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: XI New ❑Addition/Alteration CENSUS CODE <br /> R-1 .58 Description:12'X12'SHED 328-OTHER NON-RES <br /> CATEGORY ;> I Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: 2 Public ❑Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E ❑Yes ❑No <br /> SHORELAND 1�t FLOOD ZONE �yt WETLAND EC/SW NO. <br /> ❑Yes Xj No ❑Yes X No ❑Yes X No <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 144 <br /> 10 Sq.Ft. Sq.Ft. 144 PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 11,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. $ 61.00 <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 County SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit. 1 0 —is---CJ? <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? 'DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑Yes A No 15 Oct 2009 SSA1 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE PROJECT <br /> Conditions. REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VOID IF ANY <br /> MODIFICAJ_IONS itREE MADE WITHOUT THE EXPRE S WRITTEN APPROVAL OF DANE COUNTY ZONING.INITIALS -4 t / 1 <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 /> 545-112(12/05) GCS-single 1 f l_ <br /> d-1 /("3-4014:–C CO <br />