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DANE COUNTY ZONING PERMIT Page 1of2 DCPZP2015-00871 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE • JEFFREY A PIPITONE (608) 849-1982 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 6470 STATE HIGHWAY 19 (City,State,Zip) (City,State,Zip) WAUNAKEE, WI 53597 E-MAIL ADDRESS E-MAIL ADDRESS J_PI PITONE @YAHOO.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0808-122-8360-0 TOWN OF SPRINGFIELD 12 NW NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 6470 STATE HIGHWAY 19 subject to field verification.) LOT BLOCK I C.S.M. 0.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSE PROJECT: New Structure/Addition CENSUS CODE R-1 Residence .8 Description: 0'X 20'SHED 329-Other District Category ® Residential ❑ Commercial ❑ A 'cultural SEWER SANITARY PERMIT NO. ❑ Other: ROAD CLASSIFICATION REZONE NO. C.U.P.N . VARIANCE NO. DEED RESTRICTION A-US or State Highway 10733 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 200 8 Sq.Ft. Sq.Ft.200 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,800.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $65.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be pe ormed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply wi h the applicable zoning ordinances. I understand that failure to comply with any provision or condition of his permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for corn lying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. W tlands that are not associated with open water can be difficult to identify. Failure to comply may re ult in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIG Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit 7_o cT— ;C OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 10/27/2015 PMK2 ® ES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: SAS