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DANE COUNTY ZONING PERMIT Page 1 of 2 <br /> DCPZP2016--00775 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT R JOHNSON (608)455-4701 Meigs Inc (608) 767-2729 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 541 UNION RD PO Box 412 <br /> (City,State,Zip) (City,State,Zip) <br /> BROOKLYN, WI 53521 Black Earth, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> albanyair @frontier.com dave @meigsbuilds.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0509-261-8395-0 TOWN OF OREGON 26 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 541 UNION RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13120 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> A-2 Agriculture 22.08 Description:addn to existing detached accessory bldg.-cold storage 437- Non-Res Addition <br /> District no sanitary fixtures <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other Private no fixtures <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 10095 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR c C TOTAL SQUARE FEET <br /> Q 658 <br /> / a .. U Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $18,000.00 <br /> I Sq.Ft. Sq.Ft. PERMIT FEE <br /> $99.00 <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 premis-. ., Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning •rdil ances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGN' U R:: Ow e •/• - / DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. \ / Y. L )2---2-- <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/02/2016 SCW1 <br /> YES ® NO <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: . /02 ^ eR^ KL) (V\ <br />