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DANE COUNTY ZONING PERMIT DCPZP2016-00004 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANE COUNTY%CLEAN FUEL DANE,LLC (773) 255-0850 BENJAMIN P. SHEFF (404) 772-5251 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6321 CUBA VALLEY ROAD 109 S. MAIN STREET, SUITE C <br /> (City,State,Zip) (City,State,Zip) <br /> DANE, WI 53529 EATON RAPIDS, MI 48827 ta <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JHAECKEL @CLEANFUELPARTNERS.COM BENSHEFF @ES-ONLINE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0909-312-8800-0 TOWN OF VIENNA 31 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6321 CUBA VALLEY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 12937 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-B Ag-Business 10 Description:30'X 28'ADDITION TO AN EXISTING ACCESSORY 329-Other <br /> District BUILDING <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER !, L <br /> SANITARY PERMIT NO. <br /> ❑ Other: Rtf�TC 1 Y lv Qj <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10191 2134 <br /> 0 YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO <br /> ❑ YES 671 NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 840 <br /> 15 Sq.Ft. Sq.Ft.840 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $21,000.00 <br /> 1 Sq.Ft. Sq.Ft PERMIT FEE <br /> $242.00 <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' • • y , - . , DATE: <br /> Ordinances.Any unauthorized change from the information or � ' //G /��j' <br /> plans submitted will invalidate the permit. API.- . O <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 01/08/2016 PMK2 <br /> • /�� NO DATE REVIEWS INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial/ l 1 14416 SAS <br />