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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPZP-2016-00751 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BLACKHAWK SKI CLUB (608)220-6947 Daniel Osborne (608)220-6947 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4641 WINDSOR RD 6163 Reuter Road <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 Mazomanie, WI 53560 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> djomakesnow @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-171-9280-8 TOWN OF MIDDLETON 17 NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10222 BLACKHAWK 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 /> RE-1 Recreational Description:70'x 50'x 28'Ski chalet 328-Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private 13-2016-00347 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road dcprez-0000-01039 <br /> ❑ YES ❑ NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES O NO 1:1 YES ❑ NO EC 2016-0442 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 28 Sq.Ft.954 Sq.Ft.2336 <br /> 3290 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $335,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $296.75 <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.dnrstate.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 SIGNATUR •,c. ner/A. ' if DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. Y ..,,r,- / c._-- !' <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/15/201 ' RLB <br /> \ / ❑ ES ® NO DATE REV( 2_t WED INITIAL 2nd INSPECTION DATE INITIALS <br /> Initials.�( o `%�� I 4L <br />