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DANE COUNTY ZONING PERMIT DCPZP2017-00001 Page 1of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE STOUGHTON AREA VETERANS MEMORIAL PARK LLC (608)884-6039 Dane County Board of Supervisors (608)212-6423 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 803 N PAGE ST 210 Martin Luther King,Jr.BoulevardRoom 116,City-County (City,State,Zip) (City,State,Zip) STOUGHTON,WI 53589 Madison,WI 53703 E-MAIL ADDRESS E-MAIL ADDRESS broughtonduane @yahoo.com broughtonduane @yahoo.com PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0611-312-9360-0 TOWN OF PLEASANT SPRINGS 31 NW SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is subject to field verification.) I LOT C.S.M.NO.or PLAT NAME 1 1BLOCK CSM 13999 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE RE-1 Recreational Description:12.5'x 4.5'x 4.5 ground on premise sign 329-Other District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other. ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION DCPREZ-2014-10804 DCPCUP-2014-02303 o YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. YES ® NO ❑ YES 0 NO ❑ YES ❑ NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 5 Sq.Ft. Sq.Ft.55 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error 1 Sq.Ft. Sq.Ft. PERMIT FEE $0.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit,will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIIC TURE:Owner/Agent / Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. OFFICE USE ONLY (form version 03.01.00) SURVEY REQUIRED 7 DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS YES NO 01/04/2017 RLB DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: t