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DANE COUNTY ZONING PERMIT DCZONING PERMIT NO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORN1A1ION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MARK D AULIK (608)347-6244 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1148 WASHINGTON RD <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> M DAU L I K@ HOTMAI L.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0512-073-8570-0 TOWN OF ALBION 7 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 1148 WASHINGTON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 11630 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-2 Agriculture 22 Description:ACCESSORY BUILDING 329-Other <br /> District <br /> Category 0 Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Taut Road 9444 ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES (a NO ❑ YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT let FLOOR TOTAL SQUARE FEET <br /> 1632 <br /> 14 Sq.Ft. Sq.Ft.1632 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $42,868.00 <br /> 1 Sq.Ft. Sq.FL PERMIT FEE <br /> $172.40 <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 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/A! =nt DATE: <br /> Ordinances.Any unauthorized change from the Information or <br /> plans submitted will invalidate the permit. M LI . - , oil. 3.2C1 <br /> OFFICE USE ONLY (form vorsiun 03.0I.io) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/01/2018 PMK2 <br /> ❑ YES 0 NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> initials:10 ;LOA— <br />