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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 oft <br /> DCPSHL-2015-00083 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> VERIDIAN HOMES AB LLC (608)226-3100 <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 1/4 114 1/4 <br /> 0910-203-3094-0 TOWN OF WINDSOR 20 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6991 CIRCLE TRAM WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 22 HOLLAND FIELDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE - ; ? .gin ' <br /> PROPOSED PROJECT: New Structure/Addition r <br /> R-2 Residence 13703 Description:SFR r a' ` f.`j <br /> Districts <br /> PROJECT INFORMATION App for a Residential Structure; SEWER C''---:',f -- a t* _ 4 ;nt <br /> Sewer I : n <br /> REZONE NO C.U.P.NO VARIANCE NO DEED RESTRICTION -".:,.."4",,-.: <br /> 6059 D YES ® NO E y• <br /> SHORELAND FLOOD ZONE WETLAND d1 ` ` � t. <br /> 2-W <br /> 0 YES 0 NO U YES ® NO L YES ® NO , • <br /> Existing Impervious Proposed Impervious 1 �� a <br /> yyi`. i17{ - ��YYt.t1, y 7lf�µ -�Y _ .s ;� f * <br /> I y °1v. t„ lit --,;-,,,,,,r, x k v <br /> Sq.Ft.0 sq.FL 2497 r „ :°�,i. alt / 4 F. <br /> t 3 .4 ,: F n s i <br /> Setback from Ordinary High Water Mark Water Body Name r r r , 4 l',-,: <br /> f_ <br /> PERMIT FEE <br /> 250 UNNAMED xF = $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 a _rrna, ;°' <br /> Ordinances.Any unauthorized change from the information or ��-/r� <br /> plans submitted will invalidate the permit. <br /> 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 /> I <br />