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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Pagelof2 DCPS H L-2016-00040 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE MARY L FRAHM (608) 838-9063 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 3498 ORVOLD PARK DR (City,State,Zip) (City,State,Zip) MCFARLAND, WI 53558 E-MAIL ADDRESS E-MAIL ADDRESS MFRAHM @RESTAIRIOHOMES.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0610-144-5845-3 TOWN OF DUNN 14 SE SW PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 3498 ORVOLD PARK DR subject to field verification.) LOT BLOCK C.S.M.NO or PLAT NAME 5 1 ORVOLD'S PARK- ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building R-3 Residence Description:REPLACE EXISTING DECK,STAIRS TO WATER, District REPAVE DRIVEWAY ALONG FRONTAGE PROJECT INFORMATION App for a Residential Structure;App for Walkway/ SEWER Stairs: Sewer REZONE NO C.U.P.NO VARIANCE NO. DEED RESTRICTION ❑ YES NO NO SHORELAND FLOOD ZONE WETLAND YES ❑ NO YES kl NO ❑ YES © NO Existing Impervious Proposed Impervious Sq.Ft. Sq.Ft. Setback from Ordinary High Water Mark Water Body Name YAHARA RIVER PERMIT FEE $150.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: O er/A• -nt Ordinances.Any unauthorized change from the information or DATE: plans submitted will invalidate the permit. 1 \\L°\\Lc3 OFFICE USE ONLY (form version 01.01.00) DATE ISSUED INITIALS INSPECTION DATE IN,T,ALS 06/16/2016 HJ H 3 DATE REVIEWED INITIALS