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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> i DCPZP-2016-00002 <br /> OWNER INFORMATION II AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> SHAWN WEST (608)751-9344 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2727 NIGHTINGALE LN <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0711-054-2279-0 TOWN OF COT AGE GROVE 5 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION I STREET NAME ST.TYPE <br /> (Assignment of new address Is 2727 NIGHTINGALE LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NQ.or PLAT NAME <br /> 29 RAVENWOOD ESTATES- <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence Description:10'x 12'x 11'residential storage shed 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other Private <br /> I <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO.' VARIANCE NO. DEED RESTRICTION <br /> DCPREZ-1977-01812 ❑ YES ❑ NO <br /> I , <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ❑ NO <br /> I <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 192 <br /> 11 Sq.Ft. Sq.Ft.192 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $2,500.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $64.40 <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 withlthe applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of thi's 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 construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult <br /> to identify. Failure to comply may result in rerrhoval or modification of construction that violates the law or <br /> other penalties or costs. For more information,; visit the Department of Natural Resources web page 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 inspectors for the <br /> purposes of determining compliance with the Zoning ordinances. <br /> i <br /> Owner&Agent hereby agree to comply with all Dane County IGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> 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 /> 01/05/2016 RLB <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />