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DANE COUNTY SHORELAND ZONING PERMIT ZONING 2014 0. Page 1 of 2 <br /> DCPSHL-2014-00023 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT CONTRACTOR NAME PHONE <br /> NATHANIEL P SNYDER (608)839-0392 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 320 FORRESTON DR <br /> (City,State,Zip) (City,State,Zip) <br /> COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> NSNYDER21 QYAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0711-301-8050-3 TOWN OF COTTAGE GROVE 30 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2944 HOPE RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: New Structure✓Addition • '' <br /> R-3A Residence Description:NEW DUPLEX IN SHORELAND �s. . <br /> District . F r <br /> t. <br /> PROJECT INFORMATION App for a Residential Structure; SEWER a'` �i Sr� � { <br /> Septic x f 4 r i t 0 4 ,r�; <br /> DEED RESTRICTION `„,� <br /> REZONE NO. C.U.P.NO. VARIANCE NO. L `'�ra, <br /> 10518 ❑ YES ® NO . .�17 -' <br /> SHORELAND FLOOD ZONE WETLAND �"i .4 ,i� :4` 1 ,r n : .i r 5 Iir {s, <br /> ® YES ❑ NO ® YES ❑ NO ® YES ❑ NO w 5 t*�fl, 544," . z Y , r ; ` r',," <br /> Z Exisy � �h go t fi n . - t <br /> 4� <br /> ting Impervious Proposed Impervious '.f0ttlliA � a ,i 1" "u4 ' � 1 ;Mz1 pmt � h �� {'� ,.� •Sq.Ft. Sq.Ft. � t x .l ; <br /> Setback from Ordinary High Water Mark Water Body Name . . ter. ,. s ' ,x ' <br /> r a `sa�r:/: ur 1: 1'it;PERMIT FEE <br /> 6� { t, / $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 p art 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 01.01.001 <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/16/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />