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DANE COUNTY ZONING PERMIT DCPZP 2017 00678 Page 1 of2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE RICHARD T BENJAMIN BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) County Highway A (City,State,Zip) (City,State,Zip) STOUGHTON, WI 53589 E-MAIL ADDRESS E-MAIL ADDRESS PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0512-184-9840-0 TOWN OF ALBION 18 SE SE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 1460 COUNTY HIGHWAY A subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 1 CSM 00877 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE A-2 (1)Agriculture 1 Description:parking of truck 329 -Other District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. Other: Private ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION B-County Highway 6070 ❑ YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error O Sq.Ft. Sq.Ft. PERMIT FEE $45.00 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 SIGNAT: Own y, 'gent DATE' Ordinances.Any unauthorized change from the information or / . plans submitted will invalidate the permit. /ffi'`I`' J `Q /i OFFICE USE ONLY (form version 03.01.01) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 10/11/2017 S' 1 ❑ YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: