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• <br /> Application Number:APP-34444 <br /> ZONING PERMIT NO. <br /> - DANE COUNTY ZONING PERMIT Page 1 oft ZP20090253 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MELVIN KJORLIE (608)438-7432 SAME AS OWNER <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 5119 CHURCH RD <br /> (City,State,Zip) (City,State,Zip) <br /> MIDDLETON,WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KIORAM @TDS.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0808-284-9970-5 SPRINGFIELD 28 SE SE <br /> 1:Z�]J I a i/d']']:4 441E/HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject 5119 CHURCH RD <br /> to field verification.) <br /> LOT BLOCK C.S.M.NO.4r PLAT NAME <br /> METES AND BOUNDS: METES AND BOUNDS <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New ❑Addition/Alteration CENSUS CODE <br /> A-1 EX .5 Description:l2'X18'GARDEN SHED 328-OTHER NON-RES <br /> CATEGORY Residential ❑Commercial ❑Agricultural SEWER tom, SANITARY PERMIT NO. <br /> ❑Other: ❑Public 4J Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C ❑Yes ❑No <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑Yes No ❑Yes No ❑Yes No <br /> HEIGHT(In Feet) BASEMENT lat FLOOR TOTAL SQUARE FEET <br /> 10 162 162 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR Irsi FLOOR $ 3,000.00 <br /> 1 PERMIT FEE <br /> Sq.Ft. Sq.Ft. $ 62.00 <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 SIG E: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit C/ 2 y b 4 <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> Yes ❑No 29 May 2009 SSA1 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: G <br /> Condit ions: 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PRESENTED. ANY MODIFICATION TO THE PROJECT <br /> REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND VQI.IF ANY <br /> MODIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING.INITIALS ) L s�- <br /> 2. ACCESSORY BUILDING-NO HABITATION: THIS BUILDING SHALL NOT BE <br /> USED FOR HUMAN HABITATION. <br /> 545112(12ro5) GCS-multi /h /0 ,.- t ,1c: ' S t,'A V 6y /4,,,t, - a <br />