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DANE COUNTY SHORELAND Z. NING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2015-00082 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> REBECCA J MAIER-FREY DANE COUNTY PARKS (608)240-3766 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5588 RIVEREDGE RD 5201 FEN OAK DR <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE,WI 53597 MADISON,WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MARSH @COUNTYOFDANE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-212-8583-2 TOWN OF -•XBURY 21 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is <br /> subject to field verification.) <br /> LOT (BLOCK Il I C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: <br /> RE-1 Recreational Description:BRIDGE REPLACEMENT(DORF HAUS <br /> District SNOWMOBILE) <br /> PROJECT INFORMATION App for Other:BRIDGE SEWER <br /> I Septic <br /> REZONE NO. C.U.P.NO. VARIAN I E NO. DEED RESTRICTION <br /> 2083 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAN i� <br /> ® YES 0 NO 0 YES ® NO 0 S ® NO <br /> Existing Impervious Proposed Impervious up • <br /> Sq.Ft.450 Sq.Ft.600 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 0 UNNAMED , ,' PERMIT FEE <br /> $0.00 <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 SIG : Owner/: !fr DATE:. <br /> Ordinances.Any unauthorized change from the information or _ <br /> plans submitted will Invalidate the permit. ,- �`!�„' ._ <br /> -`1 OFFICE USE ONLY (form version 01 01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 09/22/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />