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DANE COUNTY ZONING PERMIT ZONINGERMT013391 Page ofDCPZP2 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOSEPH R PERTZBORN (608)575-1504 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2139 COUNTY HIGHWAY PB <br /> (City,State.Zip) (City,State.Zip) <br /> VERONA,WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JPERTZBORN@HJPERTZBORN.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4114 <br /> 0608-262-8380-1 TOWN OF VERONA <br /> 26 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2139 COUNTY HIGHWAY PB <br /> subject to field verification.) <br /> LOT 'BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 02499 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> RR-2 Rural 5.20 Description:36'X 32'ADDITION TO EXISTING SHED 329-Other <br /> Residential District <br /> Category gd Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> 0 Other: <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 /> to YES 0 NO ❑ YES ® NO ❑ YES l21 NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SOUARE FEET <br /> 1152 <br /> 16 Sq.Ft. Sq.FI.1152 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $18,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $165.20 <br /> 1, 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 SIGA,TTURE: •wner/Agent DATE: <br /> evil/ <br /> �/ <br /> Ordinances.Any unauthorized change from the information or e "' <br /> plans submitted will invalidate the permit. f,��' j •Tz( <br /> OFFICE USE ONLY (form version 04.00.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/07/2021 PMK2 <br /> ❑ YES EI NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial:1 <br />