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DANE COUNTY ZONING PERMIT Page 1of2 DCPZP 20 5-00924 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE STEVEN G NOBLE (608) 767-5700 BILLING ADDRESS(Number.Street) ADDRESS(Number,Street) 4864 PAGE LN (City,State,Zip) (City,State,Zip) BLACK EARTH, WI 53515 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0806-363-9851-7 TOWN OF BLACK EARTH 36 SW SE PROPERTY ADDRESS HOUSE NO ST DIRECTION STREET NAME ST TYPE (Assignment of new address is 4864 PAGE LN subject to field verification.) LOT BLOCK C.S.M.NO or PLAT NAME 3 CSM 08968 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE RH-3 Rural Homes 15 Description. 13'X 15'GARDEN SHED 329 - Other District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Private Other. ROAD CLASSIFICATION REZONE NO C.U.P.NO VARIANCE NO DEED RESTRICTION C-Town Road 6974 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO El YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 195 9 Sq.Ft Sq.Ft. 195 PROJECT COST NO OF STORIES 2nd FLOOR 3rd FLOOR $1,200.00 1 Sq,Ft. Sq Ft. PERMIT FEE $64.63 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 performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result 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 SIGNATURE: Owner/ en DATE: Ordinances.Any unauthorized change from the information or G�if vL l (6 plans submitted will invalidate the permit. OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 11/16/2015 PMK2 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: 111-71 \ fr-t[cS"