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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2016-00085 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN BEIL (608)424-1902 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7121 NORTH SHORE DR <br /> (City,State,Zip) (City,State,Zip) <br /> BELLEVILLE, WI 53508 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BEILJ @BELLEVILLE.K12.WI.US <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0508-342-2201-4 TOWN OF MONTROSE 34 NW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7121 NORTH SHORE DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 BELLROSE <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-1 Residence 47664 Description:25 X 25 GAR ADDN TO SFR <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 /> 1714 O YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES El NO ❑ YES ® NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious • <br /> Sq.Ft.5819 Sq.Ft.5819 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 215 LAKE BELLE VIEW 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 <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 SIGN!' RE: Ow r/A• n DAT : <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 45 /V / o <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 10/13/2016 R W L 1 <br /> DATE REVIEWED INITIALS <br />