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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2017-00036 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DEBRA G WEIS (608) 558-8431 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2057 SKYLINE DR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> COOKERWEIS @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0611-292-4333-3 TOWN OF PLEASANT SPRINGS 29 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION • STREET NAME ST.TYPE <br /> (Assignment of new address is 2057 SKYLINE DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 13 KEGONSA GROVE-1ST ADDITION <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-3 Residence 7222 Description:REMOVE EXISTING DECK AND REPLACE WITH <br /> District PATIO '; <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. <br /> DEED RESTRICTION �� rs <br /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND wi • <br /> ® YES 0 NO 0 YES ® NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.444 Sq.Ft.444 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 35 LAKE KEGONSA ti PERMIT FEE <br /> , ✓.F.. , $150.00 <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 .1 IGNATLJ R T) •; <br /> Ordinances.Any unauthorized change from the information or " <br /> plans submitted will invalidate the permit. Debra G. Weis 5/31 /2017 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE 'INITIALS <br /> 05/31/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />