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DANE COUNTY, WISCONSIN <br /> APPLICATION FOR: ZONING PERMIT PERMIT# : 1360-204 <br /> PARCEL NUMBER MUNICIPALITY SEC 1/4 of 1/4 , <br /> 071013297001 Town of Blooming Grove 13 SE NW - <br /> PROPERTY ADDRESS : 4127 CTH AB <br /> (Assignment of new address is subject to field verification) <br /> Lot : Block: Plat : <br /> CSM#: Parcel area: 9 . 00AC Old PMT# : Census cd: 319 <br /> Proposed use : Churches & other Religious New: Exclusive Agricultural <br /> 52 'x110 ' church w/ walkout <br /> Sewer: Private County Permit# 20040617 Zoning District : A-1EX <br /> Road Classification: B Road right-of-way Width: 66 <br /> Conditional use permit # : 0 Variance : N <br /> Shoreland: N Floodzone : N Wetland: N <br /> Sq ft . area Basment : 5150 1st . 5047 2nd. Total 10197 <br /> Dimensions : 52 . 000 X 110 . 000 Stories : 1 Feet : 28 . 000 <br /> Project cost : 400, 000 Permit Fee : 1000 . 00 Sq ft area: 5720 . 000 <br /> OWNER and AGENT hereby agree to comply with all WISCONSIN County <br /> ordianances . Any unauthorized change from the information or plans submitted <br /> will invalidate the permit . <br /> OWNER: AGENT: <br /> GRACE EVANGELICAL CHURCH ROBERTS CONSTRUCTION 8 ASSOCIATES, INC. <br /> P.O. BOX 8780 49 E WASHINGTON AVE <br /> MADISON WI 53708 MADISON WI 53703 <br /> 608-257-0500 <br /> SIGNATURE: Owner/Agent ` ,d% <br /> Rural address # : Y Post required: Y Installed: 11/04/2004 <br /> Issued: 11/04/2004 By: SAS 3.eviewed: Q)( /Zf/ZDD-By: / <br /> 1st inspection:6 /25 /160( By: alb Setback: Li/7 $7 ) ' L yd: L, <br /> 2nd inspection: g /&)/ if By: gi4 R yd: !% Rear: ✓MZ- 3 <br /> I � <br /> 11 ) 13J° � <br /> 2/Ut y/23/0i <br /> - O �-- <br /> 1/ 21`9(' <br />