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DANE COUNTY ZONING PERMIT ZONING ERMITNONO. Page 1of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE KOLB REV LIVING TR,DOROTHY H (608) 515-3962 AMIR MORNING (608) 906-5556 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 6617 SEYBOLD RD 1710 SHERIDAN DRIVE (City,State,Zip) (City,State,Zip) MADISON, WI 53719 MADISON, WI 53704 E-MAIL ADDRESS E-MAIL ADDRESS AMIRMORNING @GMAIL.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0708-253-8245-4 TOWN OF MIDDLETON 25 SW NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address Is 6613 SEYBOLD RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE C-2 Commercial .5 Description:WALL SIGN 329-Other District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Public ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION D-Unadopted Subdiv Streets 1038 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ❑ NO ❑ YES ® NO YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $30.00 Sq.Ft. Sq.Ft. PERMIT FEE $50.00 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 SIGNATU- : Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. 3 — i .) b OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED? - DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 03/14/2016 PMK2 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: 3 1 114, I\