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DANE COUNTY ZONING PERMIT ZONING <br /> O NZP PERMIT <br /> 02,00293 Page of <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEREMY FOXEN (608) 513-4200 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9177 COUNTY HIGHWAY KP <br /> (City,State,Zip) (City,State,Zip) <br /> BLACK EARTH, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jwfoxen@yahoo.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0707-061-8342-0 TOWN OF CROSS PLAINS 6 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9177 COUNTY HIGHWAY KP <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 10660 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> RR-8 Rural 11.106 Description:detached accessory building no sanitary 438- Garage <br /> Residential District <br /> Category ll Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ii Other: Private no fixtures <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ElYES RI NO ❑ YES ® NO ec20210181 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 1680 <br /> 18 Sq.Ft. Sq.Ft.1680 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $5,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $218.00 <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: 2 wner • • - t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. I II Nr � V6 <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 05/26/2021 SCW1 <br /> ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> InitiV 51 <br />