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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2016-00062 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAMES R CONKLIN CODY HELMEN (608) 577-7041 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4348 JORDAN DR 151 W GROVE ST <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 OREGON, WI 53575 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HELMENCONSTRUCTION28@YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-084-5462-9 TOWN OF DUNN 8 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4348 JORDAN DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 42 1 BRICTSON PARK, DUNN <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-3 Residence Description:REPLACE DECKING ON FRONT PORCH,REAR <br /> District DECK,AND GARAGE LANDING. <br /> PROJECT INFORMATION App fora Residential Structure; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES ❑ NO 0 YES ® NO 0 YES ® NO <br /> Fasting Impervious Proposed Impervious <br /> Sq.Ft. Sq.Ft. <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 68 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 <br /> subject 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 <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at 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 SIGN -U2' : Owne,i ent DAT z: <br /> plans <br /> Ordinances.Any unauthorized change from the information or i�, n /o <br /> permit.tans submitted will invalidate the i "J �v <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/10/2016 HJ H 3 <br /> DATE REVIEWED INITIALS <br />