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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2016-00067 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DANE COUNTY (608)224-3763 DANE COUNTY PARKS (608)224-3763 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 210 MARTIN LUTHER KING JR BLVD RM 114 5201 FEN OAK DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53703-3342 MADISON, WI 53718 <br /> a <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JAMES @COUNTYOFDANE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-032-8020-0 TOWN OF ROXBURY 3 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 8587 SCHOEPP RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 04959 <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: <br /> RE-1 Recreational Description:LUSSIER COUNTY PARK BOAT LAUNCH PROJECT <br /> District <br /> PROJECT INFORMATION App for Walkway/Stairs;App for Other:PARK DEVELO SEWER . • <br /> Septic <br /> PMENT <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION • <br /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES D NO ® YES [J NO ❑ YES ® NO 'I ; <br /> #v .axe• <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft. Sq.Ft � <br /> Setback from Ordinary High Water Mark Water Body Name t t <br /> z <br /> FISH LAKE if vF g- � z 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 SIGNATU' :..Owner/Agent DATE. <br /> Ordinances.Any unauthorized change from the information or ` <br /> plans submitted will invalidate the permit. / 8/2-5/1 l <br /> OFFICE l!:c ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/25/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />