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ZONING PERMIT <br /> 2016-0NO. Pagelof2 <br /> DANE COUNTY SHORELAND ZONING PERMIT <br /> DCPSHL- 016-00036 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANE COUNTY (608)224-3730 DANE COUNTY PARKS (608) 224-3743 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> CITY COUNTY BUILDING RM 114 5201 FEN OAK DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53709 MADISON, WI 53 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CLOSE.SARAH @COUNTYOFDANE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0508-032-8505-0 TOWN OF MONTROSE <br /> 3 NW 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 /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> A-1 Ex Exclusive Ag Description:REPLACEMENT OF PEDESTRIAN BRIDGE OVER <br /> District SUGAR RIVER <br /> PROJECT INFORMATION App for Other.BRIDGE SEWER <br /> Septic i z <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> [3 YES ® NO �",iii r <br /> SHORELAND FLOOD ZONE WETLAND a - <br /> 0 YES ❑ NO ® YES ❑ NO YES ❑ NO <br /> Existing Impervious Proposed Impervious i''.:. , - ,,,A- Tikk--,-::,:,:',;f---,-fr,1:t3-:*1/4«.':', W-LtAiV-'4.0Xtd5Z- ii <br /> r <br /> a <br /> Sq.Ft. Sq.Ft. ��i <br /> Setback from Ordinary High Water Mark Water Body Name ° , <br /> SUGAR RIVER Pit,:'-',7N, " ' ' ' 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 SIGNATURE: ' ner/Agent DATE`. <br /> Ordinances.Any unauthorized change from the information or r . r (1/1t5/110 <br /> plans submitted will invalidate the permit. 1 <br /> OFFICE UCE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/13/2016 HJH3 <br /> DATE REV1EWED INITIALS <br />