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t 24 16 11:38a <br /> g Meineke 608-829-1605 p.1 <br /> DANE COUNTY ZONING PERMIT PE Q6ZONING PERMIT Page lof2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME ' PHONE AGENT/CONTRACTOR NAME PHONE <br /> T1 r-"' •4 .S r0 , /44,1- ,:„,\ (608)516-4989 Wisconsin Signs&Neon (920)579-0549 <br /> EI AD (N b r,Street) <br /> ADDRESS/Number,Street) <br /> i ve r t9A.c.- �.� , 311 East 11th Street <br /> (Oily,Slate,Zip) (City,State,Zip) <br /> MADISON, WI Fond du Lac, WI 54935 <br /> E-MAIL ADDRESS ,E-MAIL ADDRESS <br /> ckkampegmail.com wisigns @live.com <br /> PARCEL NO. TOWNSHIP SECTION 114 Ira 114 <br /> 0710-041-4022-2 TOWN OF BLOOMING GROVE 4 NE SW <br /> PROPERTY ADDRESS HOUSE NO, ,ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment or new address is 4008 MILWAUKEE ST <br /> subject to veld verification.) <br /> LOT I BLOCK C.S.M.NO.or PLAT NAME <br /> 2 1 CSM 01503 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: <br /> CENSUS CODE <br /> C-2 Commercial <br /> Description:17'x 9'x 25'pylon,8'x 4'x 20's elev wall,8'x 4'x 20' 329-Other <br /> District e elev wall sign <br /> Category Q Residential 0 Commercial D Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Othe': Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway DCPREZ-2016-10995 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND ECISW NO. <br /> 0 YES m NO ❑ YES ❑ NO ❑ YES ❑ NO <br /> HEIGHT'(In Feet) BASEMENT 1st FLOOR <br /> TOTAL SQUARE FEET <br /> 25 Sq.Ft. Sq,Ft.217 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error <br /> 1 Sq.Fl. Sq.FL PERMIT FEE <br /> $300.00 <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 w. . can be difficult <br /> to identify. Failure to comply may result in removal or modification of construction th,_. .. is the law or <br /> other penalties or costs. For more information, visit the Department of Natural Re •'.. .e.t.C- . eb page at <br /> www.dnr.state.wi.us or contact the Department of Natural Resources Service <br /> I hereby consent to the entry on the permitted premises by Dane County spectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> [Owner 8.Agent hereby agree to comply with all Dane County BIG . • - : 0,&—r• ,e - DATE: <br /> Ordinances.Any unauthorized change from the Information or A <br /> plans submitted will Invalidate the permit. . '__ vii 0 2 ), /� <br /> �Ea•ta - V 7'Y <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> S ® NO 10'11/2016 RIB <br /> x r4, DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials <br /> lift--, <br /> . ' <br />