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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page 1of2 <br /> DCPZP-2018-00042 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JENSEN LLC (920)809-65121 A WILLIAM STARK (608)501-4013 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6806 SEYBOLD RD 255 BERGAMONT BLVD UNIT 102 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53719 OREGON, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1 REALKINGOFCARS @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0708-253-8555-9 TOWN OF MIDDLETON 25 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6806 SEYBOLD 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: Alteration to existing building CENSUS CODE <br /> C-2 Commercial 0.842 Description:WALL SIGN REPLACEMENT 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ <br /> Other: <br /> ther: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ 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 /> 20' Sq.Ft. Sq.Ft.75 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> Sq.Ft. Sq.Ft. PERMIT FEE <br /> $100.00 <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 subject <br /> 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 difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> 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 Count zoning inspectors for the <br /> purposes of determining compliance with the zoning ordina►�es. <br /> Owner&Agent hereby agree to comply with all Dane County SI AT E: O>"! DATE:4/sof Ordinances.Any unauthorized change from the information or ∎� 1■plans submitted will invalidate the permit. / <br /> OFFICE USE ONLY (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 02/20/2018 SLJ3 <br /> ❑ ES �NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: J }VIA\t <br />