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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DONALD D DUMMER (608) 358-1412 James Rothman (608) 839-1377 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3701 S HOPE RD 799 Central Ave., <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 Deerfield, WI 53631 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jrothman @pfscorporation.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0711-301-9520-2 TOWN OF COTTAGE GROVE 30 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3701 S Hope RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 18 Description:ag accessory building-open area for storage of tractor; 329-Other <br /> District tree farm equipment and chickens. <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> No Fixtures allowed <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ® YES ❑ NO ❑ YES ® NO ❑ YES ® NO V.L 5G 2e0 1 S— 0`i"'4 8 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1350 <br /> 12 Sq.Ft. Sq.Ft.1350 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $16,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $151.25 <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: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / +' !��S_ c3.4//e. <br /> OFFICE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 03/21/2016 SC W 1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials:C��� <br />