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DANE COUNTY ZONING PERMIT DCPZP ERMITNNO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMAS A SARBACKER (608) 575-6232 TRAVIS HALVERSON (608) 574-7662 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1487 RANGE TRL 29 COUNTY HIGHWAY I <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 MORTFORT, WI 53569 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sarbs@tds.net S'C 1 i3.S cl .1- .S. R.2± <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0508-034-8002-0 TOWN OF MONTROSE 3 SE NE <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1487 RANGE TRL <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 /> A-1 Ex Exclusive Ag 29.12 Description:agriculture building 329 - Other <br /> District <br /> Category 0 Residential 0 Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road <br /> ❑ YES p NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO 0 YES 0 NO C 2_0 / at! 0 O ( 9 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 7200 <br /> 25 Sq.Ft. Sq.Ft.7200 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $72,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <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 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: wner/A•e t ' DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. = D - 144 -17 <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE 'INITIALS <br /> 02/14/2017 SSA1 <br /> YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 5 0 '" /(c. - / 111/0( <br />