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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of2 <br /> DCPSH L-2014-00048 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT P WAHLIN TEMPLE BUILDERS LLC (608)239-2285 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1991 SKYLINE DR 2501 W BETLINE HWY#113 <br /> (City,State,Zip) (City,State,Zip) , <br /> STOUGHTON, W 53589 MADISON, WI 5373 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TTEMPLE @TEMPLEBUILDS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-292-9200-3 TOWN OF PLEASANT SPRINGS 29 NW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1989 SKYLINE DR <br /> subject to field v ' 'on.) <br /> LOT BLOCK C.S. . r PLAT NAME <br /> 1 SM 05815 <br /> Z ING DISTRICT PARCEL SQ FOOTAGE P OPOSED PROJECT: New Structure/ •dition , a , <br /> R-3 Residence 17661 .-scri pti on:NEW SFR WITH POOL <br /> District <br /> PROJECT INFORM ON App for a ResidentialStrukture; SEWER � � � �l ,,* <br /> Sewer �rir i M� 'fit <br /> a <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION , b ' ;-' <br /> ❑ YES r NO , <br /> Ak 2s t « a SHORELAND FLOOD ZONE WETLAND <br /> � _'® YES ] NO D YES )j NO - � �'4 a <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.864 Sq.Ft.5294 , <br /> i .� tx .x �, sfm.f`y w `1 a ' �- <br /> Setback from Ordinary High Water Mark Water Body Name 4'4414::� �- ia � 4:1 4 j� �k <br /> 47.1 LAKE KEGONSA �� g � , PERMIT FEE ._. :: <br /> 11 " ` pv.ri.. $150.00 <br /> ,rte. . ..* t: .... : <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 <br /> subject 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 <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at 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 -SIG TURE' 0 , _ _Ag�? `f DATE'' <br /> Ordinances.Any unauthorized change from the information or ,. <br /> plans submitted will invalidate the permit. / _ <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/18/2014 HJH3 <br /> DATE REVIEWED INITIALS <br />