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DANE COUNTY ZONING PERMIT DCPZP201600106 Page 1of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE THIRD DOOR LLC (608)437-4840 Andy Mlsna (608)212-0750 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 1523 STATE HIGHWAY 78 1523 State Road 78 (City,State,Zip) (City,State,Zip) MT HOREB, WI 53572 Mt Horeb, WI 535 E-MAIL ADDRESS E-MAIL ADDRESS info @misnahomes.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0606-221-8085-0 TOWN OF BLUE MOUNDS 22 NE NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 10043 BLESSINGWAY RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 3 CSM 10980 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE C-2 Commercial Description:8'x 4'x 8'dev sign l District 3 �a ?- 0 the_{- Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED STRICTION A-US or State Highway C/// YES ❑ NO SHORELAND FLOOD ZONE i.. WETLAND EC/SW NO. w • . ,s ❑ YES NO ❑ YES w NO ❑ „YES NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 8 . Sq:F''t.:9 Sq.Ft.32 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error 1 Sq.Ft. Sq.Ft. PERMIT FEE $75.00 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 SIGNATURE: • /- `'�/• !