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DANE COUNTY SHORELAND ZONING PERMIT DZONING CPSHL-2015-00088 <br /> -2015 N0. Page1of2 <br /> DCPSHL-2015-00088 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> AMY S MARTIN (608)235-1868 AMERICAN GARAGE BUILDERS (608) 235-1868 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6335 TOWN HALL DR 1204 ENTERPRISE DR . <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-334-9851-9 TOWN OF BRISTOL 33 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6335 TOWN HALL DR <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 06637 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> A-1 Agriculture 76209 Description:2 decks+detached garage q ` <br /> g s <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ' M d i t <br /> D YES ® NO <br /> SHORELAND ` FLOOD ZONE WETLAND 4 .. c + :7 g <br /> ® YES D NO 0 YES ® NO ❑ YES ® NO q , <br /> 3 4 ,� Utz � ��.� .����x <br /> 2 th M I <br /> Existing Impervious Proposed Impervious � - s 3�� t <br /> Sq.Ft.6620 Sq.Ft.7884 :4 y e s ,,,f s T, <br /> y1 h d1 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 90 BRAZEE LAKE ,:7 .. 1, r PERMIT FEE <br /> 0.4: 1` $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 <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 'TUR • Owner/Agent ATE: <br /> Ordinances.Any unauthorized change from the information o ri <br /> plans submitted will invalidate the permit. IL `V ) /5 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 10/07/2015 HJ H3 <br /> DATE REVIEWED INITIALS <br />