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• Application Number: WEB-21094 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANIEL A ORMAN 608-767-4930 CHRIS A AULTMAN 608-574-5987 <br /> BILLING ADDRESS (Number,Street) ADDRESS (Number,Street) <br /> 9504 UNION VALLEY RD M 4723 CTY YZ PMB <br /> (City,State,Zip) (City,State,Zip) <br /> BLACK EARTH,WI 53515 DODGEVILE,WI 53533 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CHRIS.AULTMAN r)MORTONBUILDINGS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0706-121-9541-6 VERMONT 12 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment field ne address asubject 9504 UNION VALLEY RD <br /> LOT BLOCK C.S.M.NO.nr PLAT NAME <br /> 1 ---- CSM 09174 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: A6.,New NI Addition Iteration CENSUS COPF > <br /> 2� -4 v ,� AS" Description:DETACHED GARA - <br /> CATRY' ~' <br /> Residential J ID SEWER SANITARY PERMIT NO. <br /> ❑Other: J Public �Civate - t--) <br /> Z <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO./ DEED REST <br /> G <br /> -4" --1-(o0 --- ❑Yes ❑N <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. "` °° <br /> Li Yes CI No L3 Yes ❑No CI yes ❑No <br /> HEIGHT(In Feet) BASEMENT Ist FLOOR 2�p ( U TOTAL SQUARE FEET <br /> 16" / 1200 1200 <br /> Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 63,000.00 <br /> PERMIT FEE <br /> 1 Sq.Ft. Sq.Ft $ I)4O <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances. This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted wiN invalidate the permit. <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? . _ DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> ❑Yes ❑No ' <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: — -----_.... <br /> Conditions: <br /> 545-112(12/05) WEB 0 Q <br />