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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP 2016-00061 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ALEXANDER S YEVZLIN (608)658-9657 NORTHLAND BUILDINGS (715) 874-4200 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3927 COUNTY HIGHWAY JJ 2894 58TH ST <br /> (City,State,Zip) (City,State,Zip) <br /> BLACK EARTH, WI 53515 EAU CLAIRE, WI 54703 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> asy @medicine.wisc.edu hertza @northlandbuildings.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0706-212-8000-2 TOWN OF VERMONT 21 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3927 COUNTY HIGHWAY JJ <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT 0- Bl ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex E sive At 5.925 Description:agriculture building 328-Other Non-Residential <br /> 1 'strict <br /> Pv <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway ❑ 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 /> 1680 <br /> 18.29 Sq.Ft. Sq.Ft.1680 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $24,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $176.00 <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 SIGNATURE: •w er/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 4 OP� b — 7 -- <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/04/2016 SSA1 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: l(�\J�`(�� `2`H`y' <br /> t i' 1\ <br />