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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP-2016-00514 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SOKOLOWSKI REV TR,LAWRENCE&WANDA (608) 279-0120 W1190 AMERICAN ST (414) 719-0823 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4472 BROOKVIEW CT <br /> (City,State,Zip) (City,State,Zip) <br /> WINDSOR, WI 53598 IXONIA, WI 53036 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> L.SOKOLOWSKI @AOL.COM NEAL.WIEBELHAUS @MORTONBUILDINGS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-161-9200-5 TOWN OF BRISTOL 16 NE SW <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7295 WILBURN RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 04764 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 11.14 Description:AGRICULTURAL ACCESSORY BUILDING 60 X 120 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> PENDING <br /> ® YES ❑ NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 7200 <br /> 21.75 Sq.Ft. Sq.Ft.7200 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $200,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $590.00 <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 SIGNATU- : Owner/Age t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. Aiiild , Sit lfo <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INI.LS 1st INSPECTION DATE INITIALS <br /> YES ® NO 08/12/2016 HJH3 <br /> 44/ DATE REVIEWED I .L 2nd INSPECTION DATE INITIALS <br /> i is <br />