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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2015-00925 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STEVEN G NOBLE (608) 767-5700 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4864 PAGE LN <br /> (City,State,Zip) (City,State,Zip) <br /> BLACK EARTH, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0806-363-9851-7 TOWN OF BLACK EARTH <br /> 36 SW SE <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address is 4864 PAGE LN <br /> subject to field verification.) <br /> LOT BLOCK C.S M NO.or PLAT NAME <br /> 3 CSM 08968 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-3 Rural Homes 15 Description 6'X 30'LEAN TO 329 - Other <br /> District <br /> Category IZ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO <br /> Private <br /> Other: <br /> ROAD CLASSIFICATION REZONE NO C.U.P.NO VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 6974 <br /> ❑ 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 /> 180 <br /> 8 Sq.Ft Sq.Ft. 180 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $250.00 <br /> 1 Sq.Ft. Sq,Ft PERMIT FEE <br /> $63.50 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATU-E• Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or to plans submitted will invalidate the permit. G. '4s �G IS-- <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/16/2015 PMK2 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 1116--ii 1(1 1 7 1 1 <br />