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DANE COUNTY ZONING PERMIT DCPZP-201800138 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> HUSTON LIVING TR,DALE R&JOAN M 209-6646 LA CROSSE SIGN GROUP <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4026 COUNTY HIGHWAY N 2242 MUSTANG WAY <br /> (City,State,Zip) (City,Slate.Zip) <br /> COTTAGE GROVE,WI 53527 Madison,WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 114 1141/4 <br /> 0711-212-8000-1 TOWN OF COTTAGE GROVE 21 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3951 COUNTY HIGHWAY N <br /> subject to field verification.) <br /> LOT BL I LOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 03344 <br /> ZONING DISTRICT P CEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE , <br /> C-2 Commercial 6.72 Description:ON PREMISE SIGN 329-Other <br /> District <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 14 NO ❑ YES ® NO ❑ YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 14 Sq.Ft. Sq.Ft. <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> Sq.FL 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 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�'"_ \ <br /> plans submitted will Invalidate the permit. r -2 T_ <br /> • <br /> r s - w <br /> OFFICE USE ONLY (form version 04.00.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> t. S ❑ NO DATE REVIEEWE/2018 INITIALS DJEi 2nd INSPECTION DATE INITIALS <br /> Inks: Li ia3/1g SL5' <br />