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DANE COUNTY ZONING PERMIT DCPZP 2017-00019 Page 1 of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE HOPE ROD&GUN CLUB INC (608)206-9169 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) PO BOX 142 (City,State,Zip) (City,State,Zip) MCFARLAND, WI 53558 E-MAIL ADDRESS E-MAIL ADDRESS hoperodandgunclub @gmail.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0710-354-9810-0 TOWN OF BLOOMING GROVE 35 SE SE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 3435 SIGGELKOW RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE A-1 Ex Exclusive Ag Description:20'x 12'rifle range baffle 328-Other Non-Residential District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ® Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION C-Town Road DCPREZ-0000-00000 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ❑ NO ❑ YES ❑ NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 240 8 Sq.Ft. Sq.Ft.240 _ PROJECT COST es-�,/7 NO.OF STORIES 2nd FLOOR 3rd FLOOR r F/' 1 Sq.Ft. Sq.Ft. PERMIT FEE $0.00 (o O Q r VV 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 SIGN RE: •wner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will Invalidate the permit. 2 /q / OFFICE.USE ONLY (forrn version 03.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 02/13/2017 RLB ❑ YES Cgs,NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: