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D I E COUNTY ZONING PERMIT DCPZP 20 16-00571 page 1 of 2 <br /> OWNER INFORMATION , <br /> , AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME [xiCNE A^EN Y i_•,NTRACTOr NAME PHONE <br /> DAVID LASKOWSKI 970) 903 791 ii-1;,t- TER CCt4S1 P.,CTION, INC. (920)650-4694 <br /> BILLING ADDRESS(Number,Street) t DOS+ESS,Nume.er,Street' <br /> 270 OLD LUND RD W6333 '1ACK3ARTH ROAD <br /> (City.State,Zip) (City. tax Zip) <br /> CAMBRIDGE,WI 53523 FORT ATKINSON,WI 5353$ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BSGROSKO@GMAILCOM CHASHARTER @GMAIL.COM <br /> SECTION 1/4 1/41/4 <br /> 0612363-8500-4 TOWN OF CHRISTIANA 36 SW NW <br /> PROPERTY ADDRESS HOUSE NO. DIRECTION STREET NAME ST.TYPE <br /> (A:ssi tt of new edam is 270 1ST. OLD LUND RD <br /> subject.ofiaoidraa" :IA.; : . <br /> t <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 20 Description:12'X'36'ADDITION TO AGRICULTURAL BUILDING 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial Fa Agnculd ram SEWER SANITARY PERMIT NO. <br /> ❑ Private <br /> Other <br /> ROAD CLASSIFICATION REZONE NO G.U.P.NO. f/ARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES ❑ NO <br /> SHORELAND P1OOD ZONE vzETI:AND EC/SW NO. <br /> ❑ vas ® NO ❑ yes I ... Ne G YED Li ..t <br /> HEIGHT(In Feet) BASEMENT 1st FLer.R TOTAL SQUARE FEET <br /> 432 <br /> 14 sq.Ft. Sq.rt 432 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $12,000.00 <br /> 1 Sq.Ft Sq.Ft PERMIT FEE <br /> $82.40 <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 cf 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 enft re mm t r•tl^n <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and stream. 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 wuuw.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 SIGNA U .Owner •gent i E: <br /> Ordinances.Any unauthorized change from the information or ice.. <br /> plans submitted will invalidate the permit -, -ei tr�i'� - I ■ , (O <br /> OFFICE USE ONLY (iorrn version 03 01 001 <br /> SU REQUIRED 7 DATE ISSUED INITIALS tst INSPECTION DATE INITIALS PMK2 <br /> liptit <br /> 6k YES ® DATE REVIEWED INiTWLS 2nd INSPEC LION DATE INITIALS <br /> Initials; � 4----- <br />