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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Pagelof2 <br /> DCPSHL-2015-00016 <br /> OWNER INFORMATION r a, `. 4 49EINT/c9101Wp ,1 Q Mt Rif - ' <br /> OWNER NAME PHONE AGLN r/CON FRAC I FR! O NAME PHONE <br /> JOSEPH M ROBERTSON (608) 695-9919 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Sucet) <br /> 2916 WAUBESA AVE <br /> (City.State,Zip) (City,State Zip) <br /> MADISON, WI 53711 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION — 1'4 '/4 114 <br /> 0610-053-7220-4 TOWN OF DUNN 5 SW SE <br /> SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION 72EET NAME <br /> (Assignment of new address is 2916 WAU I,H.SA AVE <br /> subject to field verification.) I <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 20 3 WAUBESA BEACH-2ND ADE ION <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-3 Residence Descnotion:RES DECK ADDN AND REMOVAL OF CONCRETE <br /> District PAD <br /> PROJECT INFORMATION App for a Residential Structure;App for Relocati SEWER <br /> ng Impervious Surfaces; Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. <br /> DEED RESTRICTION <br /> (_) YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> 0 YES D NO ❑ YES ® NO El YES Z NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft. Sq.Ft.48 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 83.29 I WAUBESA N Rivl!T FEE <br /> $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 cone, i -m;d cc nst-I,A',:)n <br /> near or on.wetiands, lakes, and streams. Wetlands that are not associated with c oi.tn water can bt., 'Iffic alt <br /> to identify. Failure to comply may result in removal or modification of construction that violates the ;aw 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 pr: ises b Dan vunty zoning inspectors for the <br /> purposes of determining compliance with the zoning ordi ance <br /> Owner&Agent hereby agree to comply with all Dane County 'r NATU : 0, t -gent ___ ?AT : <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 4` 1 /5 <br /> OFFICEU Et'N.Y ~ t.ii .; a r 'I Vr,,, t ,.f. <br /> DATE ISSU::U I:N,TIAL' I'1J —L'!' D^,IE yl' <br /> 13/30/2015 I 11J113 <br /> DATE REVIEWED I■vl I IALS I <br /> I <br /> • <br />