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DANE COUNTY ZONING PERMIT DCPZP ZONING PER70NO. Page 1of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> HUMPHREY PROPERTIES LLC (608) 837-3505 (920)419-8611 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 238 W MAIN ST N3760 HWY 55 <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 FREEDOM, WI 54130 <br /> I E-MAIL ADDRESS E-MAIL ADDRESS <br /> SSIMPSON @PACVAN.COM SSIMPSON @PACVAN.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-084-9710-6 TOWN OF BURKE 8 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4290 HOEPKER 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: CENSUS CODE <br /> C-2 Commercial 2.96 Description:40'X8'STORAGE STRUCTURE WITH OFFICE 328- Other Non-Residential <br /> District (PORTABLE) <br /> Category ❑ Residential ® Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other: Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION @ <br /> C-Town Road 00997 0 YES ® NO <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 /> 320 <br /> 9'6" Sq.Ft. Sq.Ft.320 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $18,425.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $237.00 <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/AgQnt DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. P ' <br /> u <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS m 1st INSPECTION DATE INITIALS <br /> 12/06/2017 SLJ3 <br /> ® YES ❑ NO <br /> DATE REVIEWED / INITIALS c n� 2nd INSPECTION DATE INITIALS <br /> Initials: 5 � (a/('(( 7 S L✓ <br /> LS f\crt- req u r.r- L <br /> ' ems►-c \ s-z-v* Val-7, 3.4-141 ,(,ear t sQ g N-e, plc-r\ tei <br />