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1 Ap.lication Number:APP-34747 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20090298 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RASMUSSEN FAMILY LLC (847)706-1745 CONCORDIA WIRELESS (414)403-3103 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) • <br /> 1700 BLACK CHERRY CT 505 EAST GOLF RD SUITE D&E <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA,WI 53593 ARLINGTON HEIGHTS, IL 60005 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SHARON.ARPS @VERIZONWIRELESS.COM LBERA @CONCORDIAWIRELESS.COM <br /> PARCEL NO. TOWNSHIP SECTION 4 1/4 1/4 1/4 <br /> 0709-354-9280-5 MADISON 35 SE SW <br /> •JAG]LI 4 ki-/d D1 DI:I*TAM HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject 2921 SYEN E RD <br /> to field verification.) <br /> LOT BLOCK C.S.M.NO.grr PLAT NAME <br /> METES AND BOUNDS: METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: ❑New Addition/Alteration CENSUS CODE <br /> C-2 2.77 Description:COLOCATION OF ANTENNA ON CELL TOWER 329 - OTHER <br /> CATEGORY ❑Residential A Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other:COLOCATION OF ANTENNA ON CELL TOWER ❑Public Private NA <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C 1510 ❑Yes ❑No <br /> SHORELAND ��II FLOOD ZONE y� WETLAND EC/SW NO. <br /> pm <br /> ❑Yes No ❑Yes )4 No ❑Yes )4 No NA <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 0 <br /> 130 Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR ILA FLOOR $ 35,000.00 <br /> PERMIT FEE <br /> 0 Sq.Ft. Sq.Ft. $ 270.00 <br /> 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 <br /> 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 <br /> 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 <br /> 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. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances.This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information � CeNTC� <br /> or plans submitted will invalidate the permit % / <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑Yes XI No 10 Jun 2009 HJH3 <br /> / DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: o%'"�l/' <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE <br /> Conditions: PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF ANY 0 IFICATIONS ARE MADE WITHOUT THE EXPRESS WRI EN APPROVAL OF AN CO TY ZONING. <br /> INITIALS 7 <br /> 545-112(12/05) GCS-single <br />