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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2015-00055 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DOVETAIL DEVELOPMENT INC (608)658-3788 DiIAI'ONOFRIO f KOTTKE AND ASSOCIATES, (608)833-7530 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2398 SHERIDAN DR 7530 WESTWARD WAY <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53704 MADISON,WI 53717 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> RKLAAS @DONOFRIO.CC <br /> PARCEL NO. TOWNSHIP SECTION 114 1141/4 <br /> 0810-191-6078-9 TOWN OF BURKE <br /> 19 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 4578 DOVETAIL DR <br /> subject to field verification.) <br /> LOT , BLOCK C.S.M.NO.or PLAT NAME <br /> 8- ' ���., Ito DOVETAIL SUBDIVISION <br /> ZONING DISTRICT 11 tPPArR.CEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> C-2 Commercial Description:COMMERCIAL BUILDING DEVELOPMENT <br /> District <br /> PROJECT INFORMATION App for Commercial Structure: SEWER <br /> Sewer <br /> REZONE NO C,U.P.NO VARIANCE NO DEED RESTRICTION <br /> 827 D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES ® NO 0 YES NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq,FL Sq.Ft. <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 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. We lands 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 SIGNATUR ' • ent DATE: <br /> Ordinances.Any unauthorized change from the information or j� <br /> 7-z0 <br /> plans submitted will invalidate the permit. fir �� <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/20/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />