Laserfiche WebLink
ZONING PERMIT <br /> -2016 00 Page 1 oft <br /> DANE COUNTY SHORELAND ZONING PERMIT <br /> DCPSHL2016- 028 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRADLEY W CANARD (608)345-9222 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1649 COUNTY HIGHWAY PB <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BRAD.CANARD @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0608-353-9862-6 TOWN OF VERONA <br /> 35 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 1649 COUNTY HIGHWAY PB <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 07565 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-1 Residence 25749 Description:RESIDENTIAL SHED 8X15 <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 6007 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND 3":6,4 may, Z W44, <br /> YES ❑ NO ❑ YES ® NO ® YES ❑ NO <br /> Existing Impervious Proposed Impervious ix <br /> Sq.Ft.3442 sq.Ft.3562 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 85 UNNAMED 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&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. <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 05/17/2016 HJ H 3 <br /> DATE REVIEWED INITIALS <br />