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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1of2 DCPSH L-2015-00086 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE MARK H NYHUS (608) 577-9533 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 2009 MANHATTAN DR (City,State,Zip) (City,State,Zip) VERONA, WI 53593 E-MAIL ADDRESS E-MAIL ADDRESS NYHUS6 @YAHOO.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0608-284-8185-2 TOWN OF VERONA 28 SE NE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 2009 MANHATTAN DR subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME METES AND BOUNDS ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition R-2 Residence 17987 Description:10X20 GARDEN SHED District PROJECT INFORMATION App for a Residential Structure; SEWER Septic REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ❑ YES 0 NO SHORELAND FLOOD ZONE WETLAND YES ❑ NO ❑ YES ❑ NO ❑ ', YES ❑ NO Existing Impervious Proposed Impervious Sq.Ft 2450 Sq.Ft.2530 Setback from Ordinary High Water Mark Water Body Name BADGER MILL PERMIT FEE $150.00 I, the undersigned, am the owner of the prop'ierty or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may re;;ult in removal or modification of construction that violates the law or other penalties or costs. For more,information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Age,.Y DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. l L— 64 5c T /5 OFFICE USE ONLY (form version 01.01.00) DATE ISSUED INITIALS INSPECTION DATE INITIALS 09/28/2015 SJ W 3 DATE REVIEWED INITIALS