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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 DCPZP-2021-00504 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE ROBERT L CARLSON (608) 513-1636 TRAVIS LEESER (608) 379-0132 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 5498 COUNTY HIGHWAY CV 190 PAOLI ST (City,State,Zip) (City,State,Zip) MADISON, WI 53704 VERONA, WI 53593 E-MAIL ADDRESS E-MAIL ADDRESS TLEESER@CLEARYBUILDING.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0810-191-8800-9 TOWN OF BURKE 19 NE NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 5492 COUNTY HIGHWAY CV subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE HC Heavy 1.32 Description:80'X 22'OPEN LEAN ADDN TO EXISTING 329 - Other Commercial District BUILDING, FOR CAMPER STORAGE Category D Residential 0 Commercial D Agricultural SEWER SANITARY PERMIT NO. Public ❑ Other: ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION B-County Highway ❑ YES ® NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES 10 NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 1760 16.7 MEAN Sq.Ft. Sq.Ft.1760 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $50,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $350.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.usor contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or _— 8/30/21 plans submitted will invalidate the permit. /2Cc.(A,4_ OFFICE USE ONLY (form version 04.00.01) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 08/30/2021 SLJ3 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: