Laserfiche WebLink
DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO Page 1 of 2 <br /> DCPSHL-2016-00044 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LAURIA-DOBECK JOINT REV TR,DONALD J&ESTELLE M (608)873-8560 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1942 BARBER DR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON,WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-264-1435-0 TOWN OF DUNN 26 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 1942 BARBER DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 10924 <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-3 Residence Description:REPAIR AND REPLACEMENT OF EXISTING <br /> District RETAINING WALL ON SHORELINE(APPROXIMATELY 25 <br /> PROJECT INFORMATION App for Other REPAIR RETAINING WALL SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 1031 fl YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES 0 NO (a YES 0 NO O YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft. Sq.Ft. <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 0 LAKE KEGONSA PERMIT FEE <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 s Agent hereby agree to comply with all Dane County SIGNATURE:Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. - . 6 A� C -Jo-/g <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/30/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />