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• <br /> DANE COUNTY SHORELAND ZONING PERMIT ZONING PH -2016-00 Pagel of-Z, <br /> DCPSHL-2016-00051 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION . <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRET CLOSTERMERY (608) 347-7386 HART DENOBLE BUILDERS (608) 831-4422 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 289 VALLEY RIDGE DR 7923 AIRPORT RD <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 MIDDLETON, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0811-343-0523-0 TOWN OF SUN PRAIRIE 34 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2276 GLEN OAKS C I R <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 OAKS,THE <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-1 Residence 29762 Description:SI:R IN SHORELAND *; <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER # � � <br /> Septic - , r <br /> �.'�-rte _-,:i ,Is-,,,,.Cs,'41 <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION i4.,e r= <br /> 8030 0 YES ® NO r.6n*' � . <br /> . <br /> SHORELAND FLOOD ZONE WETLAND ra g ,� �« sg <br /> ® YES 0 NO 0 YES ® NO 0 YES ia NO "f li � , '` 4 � <br /> Existing Impervious Proposed Impervious g` <br /> - "'-'-1°;- .-:-,, .-s s e ` <br /> 4. ", -s <br /> Sq.Ft.0 s Ft 5283 rf*V2,4--4,>izilt:;- ..;-::: ,=;:k".,-„:41,:i. .-S-2 ,-":41-4,9 9 ,: -',-e ar *- <br /> Setback from Ordinary High Water Mark Water Body Name ; ^ a ,a <br /> �� . <br /> " PERMIT FEE <br /> 180 KOSHKONONG CREEK i .. , � # �r .,. $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 SIGNATUR : O •ent DATE: <br /> •Ordinances.Any unauthorized change from the information or �: <br /> plans submitted will invalidate the permit. OS/2 Co / 1 b <br /> . OFFICE USE ONLY (form version 01.01.00)DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/19/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />