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DANE COUNTY ZONING PERMIT ZONING ERMIT0016 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SHILLINGSTAD TR,ROBERT B&LORRAINE J (608) 835-3710 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6227 PURCELL RD <br /> (City,State,Zip) (City,State,Zip) <br /> OREGON, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> drshillingstad @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-061-8681-0 TOWN OF OREGON 6 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6227 PURCELL RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 12214 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes 33.717 Description:lean to 329- Other <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other. <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10095 ❑ 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 /> 168 <br /> 12 Sq.Ft. Sq.Ft. 168 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $450.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $62.60 <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 ordi.ces. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN• %�,'^��'- '-n1� j DAT' <br /> Ordinances.Any unauthorized change from the information or I <br /> plans submitted will invalidate the permit. �_/�,� // II <br /> OFFICE USE Oh_Y (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITI•LS <br /> 01/27/2016 SCW1 <br /> ❑ YE ® NO DATE REVIEWED / INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 1 — @ 9- '1 r, P�K <br /> YJ <br /> ' <br />