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DANECOUNTY ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPZP-2021-00339 <br /> OWNER INFORMATION AGENT CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MAZOMANIE MHP LLC (608)949-8008 Gina Holt <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> PO BOX 457 <br /> (City,State,Zip) (City.State,Zip) <br /> CEDAREDGE, CO 81413 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> GINA.HOLT@IMPACTMHC.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0906-281-9610-0 TOWN OF MAZOMANIE 28 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 10359 COUNTY HIGHWAY Y <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 13867 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> GC General 13.37 Description:mobile home lot 18 101 -SFR(detached) <br /> Commercial District <br /> Category 0 Residential p Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other. <br /> Public <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> B-County Highway <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO 0 YES ® NO 0 YES 0 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 813 <br /> 12 Sq.Ft. Sq.Ft.813 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $56,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $131.30 <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 D/�TE: <br /> V <br /> Ordinances.Any unauthorized change from the information or / ! / s/lans submitted will invalidate the permit. 2,�r --- Cot -c Z f <br /> OFFICE USE ONLY (form version 04.00.011 <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 06/15/2021 SCW1 <br /> v ❑ YES 0 NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />