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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2016-00749 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DONALD P SQUIRE JR Buell Consulting ((414)788-1327 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2063 NORGAREN RD 1200 Riva Ridge <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 Racine, WI 53402 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> nward @buellconsulting.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-271-8730-0 TOWN OF PLEASANT SPRINGS 27 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 2096 Spring RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12213 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE <br /> A-2 Agriculture 0.23 Description:New cell tower and associated equipment shelter 328 -Other Non-Residential <br /> District <br /> Category ❑ Residential Commercial Agricultural SEWER SANITARY PERMIT NO. <br /> / ,�; Private <br /> c- <br /> ® Other: 6e:/ii i D e <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2355 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> YES ® NO ❑ YES ® NO YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 415E 'LS) Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error`1�/LS'0o0 <br /> Sq.Ft. Sq.Ft. PERMIT FEE <br /> $450.00 <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 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: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or °q„aM �w"a, "wa,b I Ill-16 <br /> plans submitted will invalidate the permit. Nathan Ward °"""-"'""" "° °"" "°�"""°"`""'�` "°` I <br /> Datr 30i611��i)JI35-06'00' <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/11/2016 AMA1 <br /> R/t ES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: -/L <br />