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ZONING PERMIT 00 Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT <br /> DCPSHL-2017- 056 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MARK HALVERSON (608)279-7620 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3054 SHADYSIDE DR <br /> (City,State,Zip) (City,State,Zip) RECEIVED' <br /> STOUGHTON,WI 53589 RE <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I <br /> PARCEL NO. TOWNSHIP SECTION A • . 1/41/4 <br /> 0611-303-6022-1 TOWN OF PLEASANT SPRINGS 30 W SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME DUPING&D DR <br /> (Assignment of new address is 3054 SH <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> JI 2 SHADY SIDE PARK <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: <br /> Description:SCREEN PORCH,ENTRY WAY,GABLES ADDITION <br /> TO EXISTING SFR <br /> PROJECT INFORMATION SEWER <br /> NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ° <br /> ❑ YES ❑ NO � il`# <br /> SHORELAND FLOOD ZONE WETLAND w Yr7@ a � e,', <br /> - 3.:- ' .- �3 x x'3' 4 ,.,3� <br /> ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO , , <br /> Existing Impervious Proposed Impervious ,. �.< ,. <br /> Sq.Ft. Sq.Ft � �l ' <br /> 2 <br /> a ,, <br /> Setback from Ordinary High Water Mark Water Body Name , a 6 , `,,• <br /> ,i2,...� x PERMIT FEE <br /> M °4 � $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 SIGN URE.Oyyn;r A •.t DATE:± <br /> Ordinances.Any unauthorized change from the information or ,'\j p <br /> plans submitted will invalidate the permit. 4 Il .0 ID <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/10/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />