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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2015-00025 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GERALDINE F JANOWSKI (608)575-8282 HOUSE DOCTORS MD (608) 576-3163 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 29200 JONES LOOP RD LOT 253 W8024 MORSE RD <br /> (City,State,Zip) (City,State,Zip) <br /> PUNTA GORDA, FL 33950 POYNETTE, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KMATZKE2 @MAC.COM MFOUNTAIN @HOUSEDOCTORSMD.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-054-2322-0 TOWN OF DUNN 5 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2970 WAUBESA AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 12 2 WAUBESA BEACH- <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition p ,�- r <br /> R-3 Residence 11920 Description:TEARDOWN REBUILD SFR W/DECK 0yae <br /> �: <br /> District <br /> PROJECT INFORMATION App for a Residential Structure;App for Relocati SEWER S �y � <br /> ng Impervious Surfaces; Septic * y <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION Fps <br /> D YES ® NO <br /> 0 <br /> SHORELAND FLOOD ZONE WETLAND **' F�� ac, <br /> d <br /> ® YES 0 NO ❑ YES RI NO ❑ YES ® NO <br /> .f..._ �' . 7,,vl' .- a._.__ ,ice,,; <br /> Existing Impervious Proposed Impervious „� i 3 ; i . <br /> Sq.Ft.3402 Sq.Ft.3356 ''5.;. y r% *� ' <br /> a <br /> 44 <br /> Setback from Ordinary High Water Mark Water Body Name {rte � <br /> 77.4 LAKE WAUBESA PERMIT 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 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 = my zo•.• ± inspectors for the <br /> purposes of determining compliance with the zoning ordina -- <br /> Owner&Agent hereby agree to comply with all Dane County SIGNAT 1- ids , - • • , DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. /�/ j /3-lc— <br /> OFFICE USA ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 04/21/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />