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DANE COUNTY ZONING PERMIT ZONING ZO s ooa4s Page l oft <br /> i •" • ' •- ' • I e AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROGER D HANSEN Grant Signs(DP Industries LLC) 608-838- <br /> _ <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 646 CHATHAM TER 2810 Syene Road <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53711 <br /> • <br /> Madison,WI 53713 <br /> E-MAIL ADDRESS EMAIL ADDRESS <br /> roger @thelittlebigloadlaundromat.com Dan @grantsigns.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41(4 <br /> 0709-352-8720-6 TOWN OF MADISON 35 NW NW <br /> •' PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 2119 FISH HATCHERY RD <br /> subject to'fieid verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE <br /> Description:10'x 3'x 13'wall sign 329-Other <br /> Category - ❑ Residential 0 Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO, VARIANCE NO. DEED RESTRICTION <br /> B-County Highway DCPREZ-2016- ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES O NO 0 YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 13 Sq,Ft. Sq.Ft.30 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $100.00 <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 constru <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can b `..,j',..,,o It <br /> to identify. Failure to comply may result in removal or modification of construction that violates {f,- _;°Vor <br /> other penalties or costs. For more information, visit the Department of Natural Resources w-< ,?=�: at <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 inspec otr�, 1;r the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner R Agent hereby agree to comply with all Dane County SIGN• ■ -E: O er/A•• t DATE: <br /> Ordinances.Any unauthorized change from the Information or �1 � <br /> plans submitted will Invalidate the permit. d• 5 <br /> 1;', .°',, OFFICE tsE ONLY (form version 03.01,00)-.. <br /> SURVEY REQUIRED 1 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07!2012016 RLB <br /> X 0 YF� ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials �CP <br />