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DANE COUNTY ZONING PERMIT DCPZP 2017-00667 Pagel of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MAUREEN L MCCARTHY (608)445-3000 DONALD ZEAL (( 1 1,O,,, <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) J <br /> 46fH l-8 F 3 t/3 L ke (4�y (."c 0, it 190 PAOLI STREET <br /> .MANi-bac-FFActd-Elt A6+47-6A-99266—(City,State,Zip) O J _j VEROtNA Zip) 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tara @wiscompany.com s�3S t 5 verona @clearybuilding.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0510-274-8005-0 TOWN OF RUTLAND 27 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 343 LAKE KEGONSA RD <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 38 Description:ag building 328 -Other Non-Residential <br /> District <br /> Category ❑ Residential ❑ Commercial ® Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: <br /> Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> O YES ® NO ❑ YES ® NO ❑ YES ® NO ec2017-0355 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR (Ca) TOTAL SQUARE FEET <br /> 24 Sq.Ft. Sq.Ft1200- ?'t O <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR i , I - O <br /> V Sq.Ft. Sq.Ft. PERMIT FEE f <br /> $0.00 c, 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 SIGNATU: : slow. /Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. /- L� l'1_1.,__. __ <br /> /O—3—J 7 <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 10/03/2017 SSA1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: 10 +.S I T Y l <br />