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DANE COUNTY ZONING PERMIT OCPZP-2016-00356 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CRAWFORD TRUSTEE,JAMES D (608)222-3429 JNB Signs Inc (608)754-6338 <br /> BILLING ADDRESS(Number.Street) ADDRESS(Number,Street) <br /> 26565 MILES RD STE 200 1221 Venture Drive <br /> (city,Slate,.Zip) (City,State,Zip) <br /> WARRENSVILLE HEIGHTS,OH 4412E Janesville,WI 53546 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ccronin©jnbsigns.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-261-6003-5 TOWN OF BLOOMING GROVE 26 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 3480 MILLPOND RD <br /> subject to field vsrlficatton.) <br /> LOT 'BLOCK C.S.M.NO.or PLAT NAME <br /> 3 BLOOMING GROVE ASSESSORS PLAT10 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> C-2 Commercial Description:grd onp,3 wall signs w/aux sign 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial Q Agricultural SEWER SANITARY PERMIT NO, <br /> ❑, Othere <br /> Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway DCPREZ-1985-03572 <br /> . 0 YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SVVV NO. <br /> O YES ® NO ❑ YES Q` NO I] YES ❑ NO <br /> HEIGHT(In Feel) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 18 Sq.Ft. Sq.FL <br /> PROJECT COST <br /> NO,OF STORIES 2nd FLOOR. 3rd FLOOR #Error <br /> 1 S9.Ft. Sq.FL PERMIT FEE <br /> $400.00 <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 construct'.. <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be • , ,t <br /> to identify. Failure to comply may result in removal or modification of construction that violates t / <br /> other penalties or costs. For more information, visit the Department of Natural Resources webj <br /> 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 inspect / he <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE:,_Qwner/.a. J DATE: <br /> Ordinances.Any unauthorized change from the Information or . r,/ IF plans submitted will Invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/16/2016 RLB <br /> ❑ YES 41 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Irclials. <br /> '''';-,----,:„- iii'1 f!air' <br />