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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of2 <br /> DCPSHL-2016-00027 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MULTIPLE OWNERS ULTIMATE EXCAVATING (920)650-1135 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> MULTIPLE ADDRESSES W7845 STATE HIGHWAY 106 <br /> (City,State,Zip) (City,State,Zip) <br /> FORT ATKINSON, WI 53538 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MGLOCKZ @AOL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-191-3409-6 TOWN OF PLEASANT SPRINGS 19 NE NW <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 /> 9 WILLIAM'S POINT- <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: 1 9 <br /> 1 <br /> R-3 Residence Description:RESTORATION OF SHORELINE AFTER ICE HEAVEN 3 3 �$ � '3 "r <br /> District <br /> 333333 .3 + 1�Ih3 3j�'j /N <br /> PROJECT INFORMATION App for Landscaping; SEWER ` t 4 « ,a 3 ' <br /> Sewer <br /> y4llaSa* <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ev f 3 a <br /> YES ❑ NO <br /> SHORELAND FLOOD ZONE 'WETLAND <br /> YES NO ® YES NO YES ® NObs 344s <br /> Existing Impervious Proposed Impervious ( 3r i <br /> �1 9a � f/ i'7 Y 5 <br /> Sq.Ft. Sq.Ft. <br /> 4:1111,4, <br /> Setback from Ordinary High Water Mark Water Body Name ea,� 1, p4 gYa+i� 9. a "�g Wf 3; ; ° i f � . <br /> LAKE KEGONSA 4 i' , " lr3 t r :PERMIT FEE <br /> X31 f 3��� , 3� $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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or 7'�7 <br /> plans submitted will invalidate the permit. Mara Qcur 5-17-16 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 05/16/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />