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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2015-00087 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DONALD D DUMMER (608)358-1412 JAMES ROTHMAN (608)839-1344 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3701 S HOPE RD 799 CENTRAL AVE <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 DEERFIELD, WI 53531 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DONDUMMER @YAHOO.COM JROTHMAN @PFSCORPORATION.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0711-301-9520-2 TOWN OF COTTAGE GROVE 30 NE SE <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 C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: <br /> A-1 Ex Exclusive Ag 244105 Description:AGRICULTRUAL ACCESSORY BUILDING 30 X 46 ; s - kPIL <br /> District WA_ . <br /> PROJECT INFORMATION App for Agricultural Structure; SEWER 4: :f <br /> Septic - —. <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTIONr rr -.• <br /> 0 YES ® NO fr r <br /> SHORELAND FLOOD ZONE WETLAND :; ° ' <br /> ® YES D NO 0 YES ® NO 0 YES ® NO t <br /> Existing Impervious Proposed Impervious , <br /> Sq.Ft.1850 Sq.Ft.3230 '� 4 <br /> Setback from Ordinary High Water Mark Water Body Name 't^g``a,..' ; <br /> 225 UNNAMED , 1-1:.:" .‘l i PERMIT FEE <br /> � _ ,f, -°x ; - <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 <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 'sidiatuikei Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. -�" _ a c91/J. <br /> v <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 10/05/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />