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DANE COUNTY ZONING PERMIT DCPZP-2016-00725 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> WEST DANE CONSERVANCY LLC (608) 213-9641 (608) 213-9641 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2910 LAKELAND AVE 2910 LAKELAND AVE <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53704 MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0806-312-8520-0 TOWN OF BLACK EARTH 31 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4987 REEVE RD <br /> subject to field verification.) <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 25.5 Description:Addition to storage shed/existing foundation. 328 - Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ othe Private <br /> r <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES D NO 171 YES ® NO ® YES ❑ NO N/A <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1360 <br /> Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $152.00 <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 zoni • • 4. .nces. <br /> Owner&Agent hereby agree to comply with all Dane County SIG I "l . • ner/Agent D.TE: <br /> Ordinances.Any unauthorized change from the information or / <br /> plans submitted will invalidate the permit. WAWA A (1)01/4)t 2n i,6 <br /> OFFICE USE ONLY (fors,version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED 'INITIALS 1st INSPECTION DATE INITIALS <br /> 11/01/2016 DJ E 1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: (1 2 t <br />