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DANE COUNTY ZONING PERMIT Page 1 of <br /> DCPZP-2016-00697 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JACS PROPERTY MADISON EAST LLC (920)427-4458 Keller, Inc. (920)427-4458 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4008 MILWAUKEE ST PO Box 620 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53714 Kaukauna, WI 54130 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bpoch@kellerbuilds.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <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 of new address is 4008 MILWAUKEE ST <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO or PLAT NAME <br /> 2 1 CSM 01503 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> C-2 Commercial Description:Auto service center-Meineke Car Care 322 - Repair Garage <br /> District <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> El Other: Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 10995 <br /> D YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES IA NO ❑ YES ® NO El YES IA NO SM2016-0364 & EC2016-0363 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 28 Sq.Ft. Sq.Ft.7047 <br /> 7047 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $1,000,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $2200.00 <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 <br /> subject 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 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 www.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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/21/2016 DJ E 1 <br /> ® YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />