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Ap•Iication Number:APP-35560 <br /> - DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090397 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> • <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS KOT (608)834-0931 SAME AS OWNER <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 16109 RONDEVOO <br /> (City,State.Zip) (City,State,Zip) <br /> STONE LAKE, WI 54876 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KOT53590 @AOL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/a 1/4 1/4 <br /> 0911-293-2428-6 BRISTOL 29 SW Nw <br /> :(.]Li 4:I 1"/.11111 N*fill HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject 6718 SAM H I LL D R <br /> to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 8 PLAT: HOMESTEAD ESTATES <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: XI New ❑Addition/Alteration CENSUS CODE <br /> A-1 .89 Descr ption:12'X12'SHED 328-OTHER NON-RES <br /> CATEGORY XI Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: ❑Public )I Private <br /> ROAD CLASSIFICATION REZONE NO C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E ❑Yes ❑No <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑Yes X No ❑Yes ,+��yy{{�I No ❑Yes .+W No <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 144 <br /> 12 144 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 4,000.00 <br /> PERMIT FEE <br /> 1 <br /> Sq.Ft. Sq.Ft. $ 61.00 <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent s,�j D TEy <br /> Ordinances.Any unauthorized change from the information ( � <br /> or plans submitted will invalidate the permit _�6` <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPE TION DAT INITIALS <br /> CI Yes ❑No 09 Jul 2009 SSA1 26/05' <br /> DATE REVIEWED INITIALS 2nd INS ECTION D/��TE INI LS <br /> Initials: 7/1 /O <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE <br /> Conditions: PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF ANY MODIFICATIONS ARE MADE WjT O THE EXPR $ EN A/jj/_OVAL OF D E UNTY ZONING. <br /> INITIALS Y� /0, .373 �/0' 2 5(y)( b 2 Q`s <br /> 2. SURVEY ADVISORY NOTE: A LO A ION SURVEY MA BE REQUIRED TO VERIFY THAT THE <br /> BUILDING IS CONSTRUCTED ACCORDING TO THE PLAN SUBMITTED WITH THIS APPLICATION. <br /> 545-112(12/ ) GCS-single / c <br />