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DANE COUNTY ZONING PERMIT ZONING PERMIT NO P°�`,' of2 <br /> DCPZP-2016-00518 <br /> OWNER INFORMATION AGENT CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STATE OF WISCONSIN (608)267-0422 fll c44,6,1 $ Sm45, /Aii(. _ og-75-9-4‘o/ <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> DEPT OF ADMINISTRATION 101 E WILSON ST 33D 615171A rvE <br /> (City,State,Zip) (City,S te,Zip) <br /> MADISON,WI 53707-7866 VANtrSV/Itej AV, 535Y‘ , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bill.napier@wisconsin.gov ..7>LEwEcZ-A) \ c_✓u- - m i' l. <br /> SECTION 1/4 1/41/4 <br /> 0710-072-1302-9 7 <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 204 S Thornton AVE <br /> subject to field verification.) <br /> C.S.M.NO.or PLAT NAME <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> Development District 5.104 Description:temporary crane 329-Other <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Othe Public <br /> r: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 0 <br /> 240 Sq.Ft Sq.Ft <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> 0 Sq.Ft Sq.Ft PERMIT FEE <br /> $200.00 <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 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 removal 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 /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will Invalidate the permit. --� f,� /d <br /> OFFICE USE ONLY (form vcitiion 03.01.001 <br /> SURVEY REQUIRED? DATE ISSUED INITIALS let INSPECTION DATE INITIALS <br /> 08/15/2016 SSA1 <br /> ❑ YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />