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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1of2
<br /> DCPSHL-2016-00032
<br /> OWNER INFORMATION � AGENT/CONTRACTOR INFORMATION
<br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE
<br /> DANE COUNTY DANE COUNTY PARKS I
<br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street)
<br /> CITY COUNTY BUILDING RIO 114 5201 FEN OAK DR
<br /> (City,State,Zip) (City,State,Zip)
<br /> MADISON, WI 53709 MADISON,WI 53718
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4
<br /> 0508-034-9005-0 TOWN OF MONTROSE 3 SE SW
<br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE
<br /> (Assignment of new address is 6974 PAOLI RD
<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: x 0z ,,
<br /> A-1 Ex Exclusive Ag Description:FALK WELLS BRIDGE OVER SUGAR RIVER # �_
<br /> District - i 'A����
<br /> v
<br /> PROJECT INFORMATION App for Other.BRIDGE SEWER "
<br /> 3 8 L4'
<br /> REZONE NO C.U.P.NO VARIANCE NO. DEED RESTRICTION
<br /> ❑ YES ® NO 01.1=a r
<br /> ' ` " u r
<br /> m
<br /> SHORELAND FLOOD ZONE WETLAND ,a , t,,4 c 's ' a 4.
<br /> ® YES 0 NO 0 YES 0 NO ® YES 0 NO '?s ,--: to_ ti,K* tt:;la s}.,.._%O `.. n_
<br /> Existing Impervious Proposed Impervious t , � � , �
<br /> �x f k� ss� r5, eR ,, r f �, -
<br /> Sq.Ft. Sq.Ft a. . x'R:i. s S . , 144 '4 •� it , �».
<br /> Setback from Ordinary High Water Mark Water Body Name i- .,,,,,,,,I;;,.,....,;,,, ,,,,,,,,,
<br /> � s ` �� - ,_ _ , ., __Li ,__,
<br /> SUGAR RIVER k reei,.',W,A,
<br /> ;PERMIT FEE
<br /> $0.00
<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 N•TURE:`owner/Agent DATE:
<br /> Ordinances.Any unauthorized change from the Information or I
<br /> plans submitted will invalidate the permit. 4 ,j//4 , � �A /j .
<br /> OFFICE USE ONLY (form version 01.01.00)
<br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS
<br /> 05/26/2016 HJH3
<br /> DATE REVIEWED INITIALS
<br />
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