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DANE COUNTY ZONING PERMIT DCPZP 2017 00579 Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEFFERY J BORNITZKE (608) 575-7919 JULIE WOLFGRAM (608) 206-7347 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> PO BOX 188 P.O. BOX 188 <br /> (City,State,Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 MARSHALL, WI 53559 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ROOTSINTHEGROUNDCSA @GMAIL.COM ROOTSINTHEGROUNDCSA @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0912-284-9540-0 TOWN OF YORK <br /> 28 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is . COUNTY HIGHWAY TT <br /> subject to field verification.) Go Go J <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 83.7 Description:30'X 70'HOOP HOUSE 329 - Other <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other:FARM BUILDING <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES ❑ NO <br /> r <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO © YES ❑ NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 2100 <br /> I 14 Sq.Ft Sq.Ft.2100 , <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $8,000.00 <br /> 1 Sq.Ft Sq.Ft. PERMIT FEE <br /> $0.00 <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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or - I / ^ <br /> plans submitted will invalidate the permit. _4 • /..., I •, / <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQU RED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/01/2017 P M K2 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: Ctil!)7 s(^T <br />