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DANE COUNTY ZONING PERMIT DCPZP 2016-00774 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BARTON R SORENSON (608) 455-1881 Sub" C.f,-.1.) 8r,y f.,..)C 60,9 5'j.7-40 f i� <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 290 US HIGHWAY 14 1-6-t- y <br /> (City,State,Zip) (City,SW.e,Zip) <br /> BROOKLYN, WI 53521 l r" w f J Y-31-2 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> d A (. <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0510-293-9185-6 TOWN OF RUTLAND 29 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 290 US HIGHWAY 14 <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT -PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Ex Exclusive Ag 6.01 Description:27'x38'addition to existing agriculture building 437- Non-Res Addition <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway YES ® NO <br /> Ej SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES Ill NO 0 YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1026 <br /> 18 Sq.Ft. Sq.Ft. 1026 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $20,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $0.00 <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 pertalties or costs. For more information, visit the Department of Natural Resources web <br /> page at wvvw.dnr.stgletwi.us orcontact-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 SIGN URE: Own r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or 2 -./c) -a plans submitted will invalidate.the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/02/2016 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 1 :X -A - / ��{' <br />