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Ap•Iication Number:APP-23621 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> ZP20080545 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KURT USELMAN (608)643-0736 SAME AS OWNER <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 6999 KIPPLEY RD <br /> (City,State,Zip) (City,State,Zip) <br /> SAUK CITY,WI 53583 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HOLLYUSELMAN @AOL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0907-214-8701-6 ROXBURY 21 SE NW <br /> M Cl4 J 4:i ia_1 HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is subject <br /> to field verification.) 6999 KIPPLEY RD <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CERTIFIED SURVEY MAP: CSM 08294 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: XI New ❑Addition/Alteration CENSUS CODE <br /> RH 1 2 Description:16 X 20 SHED 328 OTHER NON-RES <br /> CATEGORY XI Residential ❑Commercial ❑Agricultural SEWER SANITARY PERMIT NO. <br /> ❑Other: 16 X 20 SHED ❑Public Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C 5015 ❑Yes ❑No <br /> SHORELAND FLOOD ZONE �y WETLAND EC/SW NO. <br /> ❑Yes ,I No ❑Yes X No Cl Yes X No <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 320 <br /> 13 320 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 3,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft. 74.00 <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances. This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIG ATUREOwner/Age nnttt DATE: <br /> Ordinances.Any unauthorized change from the information �!• ` C/�2��/" <br /> or plans submitted will invalidate the permit <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INS IUTION DATE INITIALS <br /> ❑Yes A No 01 Aug 2008 SCW1 >' 1 z <br /> � <br /> �tp DATE REVIEWED INITIALS 2nd INSPEdTION DAT i INITIALS <br /> Initials:_ ` ►lL4 <br /> 41 I . 'I <br /> /( v ^ <br /> 1.THIS APPROVAL BY DANE COUNTY ZONING IS ONLY FOR THE PLAN AS PR SENTED.(ANY MODIFICATION TO THE <br /> Conditions: PROJECT REQUIRES THE EXPRESS WRITTEN APPROVAL BY DANE COUNTY ZONING. THIS PERMIT SHALL BE NULL AND <br /> VOID IF ANY (O�DIFICATIONS ARE MADE WITHOUT THE EXPRESS WRITTEN APPROVAL OF DANE COUNTY ZONING. <br /> INITIAL y <br /> 2.SURVEY ADVISORY NOTE: A LOCATION SURVEY MAY BE REQUIRED TO VERIFY THAT THE <br /> BUILDING IS CONSTRUCTED ACCORDING TO THE PLAN SUBMITTED WITH THIS APPLICATION. <br /> 545-112(12/05) GCS-single <br />