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1 <br /> I <br /> ZONING PERMIT NO. Page 1 of 2 f <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2015-00074 <br /> OWNER INFORMATION AGENT/'CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> VERIDIAN HOMES AB LLC 608226310 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6801 SOUTH TOWNE DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53713 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0910-203-3116-0 TOWN OF WINDSOR 20 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7003 CIRCLE TRAM WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 24 HOLLAND FIELDS <br /> R-2 Residence 12621 Description:SFR 1 <br /> PROJECT INFORMATION APP for a Residential Structure; SEWER <br /> Sewer <br /> REZONE • NO VARIANCE NO. DEECI RESTRICTION <br /> •i . �, • 1 1 I - <br /> SHORELAND FLOOD ZONE WETLAND <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.0 Sq.FL 2521 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 250 UNNAMED 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 I <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. i <br /> ■ <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 E_ '- 1-,::", =�`; 4 r;G,=°i.: <br /> Ordinances.Any unauthorized change from the Information or - .r1 <br /> plans submitted will Invalidate the permit. MV Illi / / ' -- <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 09/02/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />