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Ap•Iication Number:APP-35014 DANE COUNTY ZONING PERMIT ZONING PERMIT NO. ZP20090332 OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE LARUE FIELDS LLC (785)764-9473 CONCORDIA WIRELESS (414)403-3103 BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) 2561 COFFEYTOWN RD 505 EAST GOLF RD SUITE D&E (City,State,Zip) (City,State,Zip) COTTAGE GROVE,WI 53527 ARLINGTON HEIGHTS, IL 60005 E-MAIL ADDRESS E-MAIL ADDRESS DDYE @STASTIE.COM LBERA @CONCORDIAWIRELESS.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0811-323-6637-0 SUN PRAIRIE 32 SW SE J:t•1 J 4 a CI 1l A* HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is subject 2785 LARUE FIELDS LN to field verification.) LOT BLOCK C.S.M.NO.9/PLAT NAME 7 PLAT: LARUE FIELDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New gl Addition/Alteration CENSUS CODE C-2 2.373 Description:ATTACH ANTENNA TO EXISTING CELL TOWER 329 - OTHER CATEGORY ❑Residential M Commercial ❑Agricultural SEWER SANITARY PERMIT NO. ❑Other:ATTACH ANTENNA TO EXISTING CELL TOWER ❑Public Private NA ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C 1403 ❑Yes ❑No SHORELAND FLOOD ZONE �t pl WETLAND iii EC/SW NO. 1�1 ❑Yes pt No ❑Yes X]I No ❑Yes No NA HEIGHT(In Feet) BASEMENT 1sf FLOOR TOTAL SQUARE FEET 110 0 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 35,000.00 PERMIT FEE 0 Sq.Ft. Sq.Ft. $ 270.00 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. 2. I,the undersigned,hereby certify that: • I have made a diligent inquiry into the applicability of any official map to the applicants'land; • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; • I have not relied upon any statements of County employees in giving these assurances; • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper permit from the appropriate village or city shall be null and void. 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this zoning permit and terminating with issuance of a certificate of • pliance or until earlier revoked in writing by the owner of the property. Owner&Agent hereby agree to comply with all Dane County 1 •NATURE: Owner/Agent • E: Ordinances.Any unauthorized change from the information ,1 x,.11, �--/ y ..te� J ,� or plans submitted will invalidate the permit OFFICE USE ONLY SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECT ON DAT INITypLSS ❑Yes ;4 No 22 Jun 2009 HJH3 V.3C10 I air ��` DATE REVIEWED INITIALS 2nd INSPECTION AT INI A S`7136/0 7 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE Conditions: PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND V( In iG pNY MO IONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. ,1lQsd.--+ 2(2,6/Ut 545-112(12/05) GCS-single