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DANE COUNTY ZONING PERMIT DCPZP201�&00266 Pagelof2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENTICONTRACTOR NAME PHONE <br /> STEVEN M SCHMIT (262)893-7217 <br /> BILLING ADDRESS(Number,Shoal) ADDRESS(Numbor,Street) <br /> 4546 AMERICAN WAY <br /> (CUy,Slate,Zip) (City,Slate,Zip) <br /> COTTAGE GROVE, WI 53527 <br /> EMAIL ADDRESS t 1 E•MA1L ADDRESS <br /> •s eehrnfdtthetmaii.com ,SS C�1 r3 i r- /f h r" a;L cam, <br /> PARCEL NO TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0711-034-6177-9 TOWN OF COTTAGE GROVE 3 SE SE <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 4546 AMERICAN WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 17 AMERICAN HERITAGE <br /> ZONING DISTRICT PARCEL ACHEAGE —PROPOSED PROJECT. New Structure/Addition CENSUS CODE <br /> R-1 Residence DeacriptIon,16'x 10'x 8'Residential storage shed 329-Other <br /> District <br /> Category la Residential ❑ Commercial 0 Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other <br /> ROAD CLASSIFICATION REZONE NO. C.U.P,NO. VARIANCE NO. GEED RESTRICTION <br /> dcprez-000-01789 [] YES p NO <br /> SHDRELAND FLOOD ZONE WETLAND EC/SW NO. <br /> o YES @ NO ❑ YES 0 NO 0 YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 160 <br /> 8 Sq.Ft. Sq.FI,160 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,000.00 <br /> 6q.FL Sq.FI. PERMIT FEE <br /> $65.00 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the la. or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web p 3- <br /> www.drtr.state.vwi.us or contact the Department of Natural Resources Service Center. ..� r .� <br /> I hereby consent to the entry on the permitted premises by Dane County zoning Insp :, `'-,le <br /> purposes of determining compliance with the zoning ordinances. '' <br /> Owner 8 es.Agent <br /> Any e n u agree to comply with all Dane County SIGNA Owner/ gent DATE: <br /> Ordinances.An unauthorized change from the Information or _ h <br /> plans submitted will Invalidate the permit. - / /-„ V6 <br /> OFFICE USE ONLY (form version 03,01.00) <br /> SURVEY REQUIRED 7 DATE ISSUED INITIALS tat INSPECTION DATE INITIALS <br /> IY3l17RO 16 RIB <br /> ❑c YES I I NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITALS <br /> _ ' <br /> rte -7", <br /> . r1 i <br /> � � .�� /9Cc e_ 200 , -- Oo S 3F <br />