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DANE COUNTY ZONING PERMIT ZONING PERMIT N0. Page 1 of 2 <br /> DCPZP-2021-00326 <br /> : .°OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JT SCHOOL DIST NO 1 (608) 767-2586 Performance Services (414) 367-5066 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> US HIGHWAY 14 N14W23833 Stone Ridge Dr.,#210 <br /> (City,State,Zip) (City,State,Zip) <br /> MAZOMANIE, WI 53560 Waukesha, WI 53188 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JSinz@wisheights.k12.wi.us mboettcher@performanceservices.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 22 NW SE <br /> 0806-222-9500-1 TOWN OF BLACK EARTH <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10173 US HIGHWAY 14 <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 /> RM-16 Rural Mixed- 41.57 Description:elementary school addition to existing middle and high 326-Schools <br /> Use District school <br /> Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Public <br /> Other:school addition <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> A-US or State Highway 1 156 <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES 0 NO ❑ YES NO YES ® NO sm20210058 59 <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 22 Sq.Ft. Sq.Ft.81014 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $0.00 <br /> 2 Sq.Ft.3608 Sq.Ft. PERMIT FEE <br /> $0.00 <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.w.i usor 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 SIGNAT 'E; •wne I),gent DATE: <br /> Ordinances.Any unauthorized change from the information or/ �// <br /> plans submitted will invalidate the permit. Y � 4 Id 1 <br /> OFFICE;'SE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/11/2021 SCW1 <br /> ❑ YES 21 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> In, Is: <br />