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• Ap.lication Number:APP-38110 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090623 <br /> • OWNER INFORMATION ( AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RICHARD PEREZ (608)234-8901 SAME AS OWNER <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 3619 NATVIG RD <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE,WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> RIOHARD.PEREZ @MED.GE.COM <br /> PARCEL NO. I TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0711-282-3345-1 COTTAGE GROVE 28 NW Nw <br /> •1: 4;A 1/d'l 0:4 41^111111 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 3619 NATVIG RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 5 PLAT: ROLLING WHEELS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: gl New ❑Addition/Alteration CENSUS CODE <br /> R-1 0.367 Description:16'X 12'X 11'DET STOR SHED 328-OTHER NON-RES <br /> CATEGORY X Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: ❑Public X Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO DEED RESTRICTION <br /> E 3877 ❑Yes ❑No <br /> SHORELAND FLOOD ZONE 1 WETLAND EC/SW NO. <br /> xi❑Yes X No ❑Yes No ❑Yes No <br /> HEIGHT(In Feet) BASEMENT ]it FLOOR TOTAL SQUARE FEET <br /> 11 192 192 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 2,500.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. $ 64.00 <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 ., - 'V 20/0/ �� <br /> a�L!/i L' • <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTIO DATE INITI LS <br /> ❑Yes L7 No 29 Sep 2009 RLB E?/ 2/7 0 <br /> DATE REVIEWED INITIALS 2nd INSPI DATE INITIALS, <br /> Initials: 2-tlp` j0 K <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 V l NY <br /> M/0.C2-Sr R)ylA E1, 25/E�XPJ))S WRV Eta,&�O2 L .0 COUNTY ZONING.INITI <br /> 2. SURVEY ADVIS�RY NOTE: A LOCATION SURVEY MAY BE REQUIRED TO VERIFY THAT THE <br /> BUILDING IS CONSTRUCTED ACCORDING TO THE PLAN SUBMITTED WITH THIS APPLICATION. <br /> 545-11 (12/05) GCS-single <br /> ,� c e� c - tea <br /> •si) <br />