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DANE COUNTY ZONING PERMIT DCPZP-2016-00728 Page of <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> HOWARD JT REV TR (608)228-5063 James Howard <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 177 GLENWAY RD Same <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> james@li+�ew+ e,ret, i i .1,e ,,r e , .t el <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0509-344-8502-0 TOWN OF OREGON 34 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 177 GLEN WAY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 10725 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RH-4 Rural Homes 1� 7a.7. Description:63'x 48'x 18'chicken coop&personal storage shed 329-Other <br /> District <br /> Category 0 Residential 0 Commercial ® Agricultural SEWN s SANITARY PERMIT NO. <br /> 0 Other: j I V A€ <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> (^ _ DCPREZ-2003-08651 <br /> �/ / ❑ YES D NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES BJ NO 0 YES NO 0 YES O <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 3024 <br /> 18 Sq.Ft. Sq.Ft.3024 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $26,400.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $276.80 <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 water can be difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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: Ow,er/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will Invalidate the permit. �, 1 , , ■ '/! 9- /(o <br /> OFFICE USE ONLY (f(rm version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> YES ® NO 11/02/2016 RLB <br /> DATE REVIEWED i/� INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: I, L - /t,� ? fV\ <br />