DCPSHL-2016-00050 - Laserfiche WebLink

Home Browse Search

DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1of2 DCPSHL-2016-00050 2•_ 6"59'1 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE CROCKER REV TR, BEVERLY A 12 GAUGE CONSTRUCTION,LLC (608)220-0376 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 3158 WAUCHEETA TRL 1223 W LINDEN RD STE 2 (City,State,Zip) (City,State,Zip) MADISON, WI 53711 IXONIA, WI 53036 E-MAIL ADDRESS E-MAIL ADDRESS DALEH @12GCC.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0610-051-4282-8 TOWN OF DUNN 5 NE SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 3158 WAUCHEETA TRL subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 2 CSM 02790 ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building F R-2 Residence 23870 Description:ADDITIONS TO SFR , `y District N ` a PROJECT INFORMATION App for a Residential Structure; SEWER 7 fix` - Sewer REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ❑ YES la NO SHORELAND FLOOD ZONE WETLAND , a ® YES 0 NO 0 YES ® NO ❑ YES ® NO 5 p Existing Impervious Proposed Impervious �� y Sq.Ft.5375.8 Sq.Ft.8099 t Setback from Ordinary High Water Mark Water Body Name 21� ",,,;,,,,,C' y , 89 LAKE WAUBESA PERMIT FEE $150.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department-of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County Si RE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. 4..(11P — OFFICE USE ONLY (form version 01.01.00) DATE ISSUED INITIALS INSPECTION DATE INITIALS 07/19/2016 HJH3 DATE REVIEWED INITIALS