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DANE COUNTY ZONING PERMIT Pagel oft <br /> DCPZP-2016-00254 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> TOWN OF VERONA 845-7187 Tim Homan 417-9331 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 335 N NINE MOUND RD 319 Jenna Dr. <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 Verona, WI 53593 <br /> E-MAIL ADDRESS ,,At E-MAIL ADDRESS <br /> QacnOld @ i'�w;'1.."-rOna- , *vs) 't . U.S t irn �* komn cR cm . cowl <br /> i PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0608-082-9220-0 TOWN OF VERONA 8 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7669 COUNTY HIGHWAY PD <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-2 Agriculture 18 Description:Town of Verona,TOWN HALL bldg. 325 - Public Works <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ® Other Private 13 - 2016-00097 <br /> ROAD CLASSIFICATION REZON 0. iN. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. SM <br /> ❑ YES /NO ❑ YES ® NO ❑ YES ® NO [(_2015-0405, 2015-0406 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 24 Sq.Ft. Sq.Ft.6250 Ggs <br /> PROJECT COST 7 ---NO.OF STORIES 2nd FLOOR 3rd FLOOR -*Error-O ??, !, L <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $0.00 <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: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> A ,ft-- A 5/27//6 <br /> OFFICE USE ONLY (form version 03.01..00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/12/2016 DJ E1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: `tom n0)f, l W P M VN <br />