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DANE COUNTY ZONING PERMIT DCPZP 2017 00511 Page1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BLUE SUN LLC (608) 576-7364 QUALITY WEST CONSTRUCITON (608) 798-3774 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 10147 THUNDER RD PO BOX 12 <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 MT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MTPLOW@MHTC.NET QUALITYWESTI NC @GMAT L.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0707-332-8160-0 TOWN OF CROSS PLAINS 33 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4443 COUNTY HIGHWAY J <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 09510 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> LC-1 Limited 6 Description:COLD STORAGE BUILDING 54X104 328 -Other Non-Residential <br /> Commercial Dist <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> p Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway 07566 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> 0 YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 5616 <br /> 35 Sq.Ft. Sq.Ft.5616 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $125,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $450.00 <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 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 SIGNAT - a w • a DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. - - i� WI • <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 44;.i'ES ® NO EW 1!2017 SLJ3 <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: L'e gr—a) <br />