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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2016-00060 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEFFREY T BALLMER (608)437-4636 ROBERT FELLER (608)444-6988 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9661 HOWERY RD 6917 RAMSEY RD <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 MIDDLETON, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JTBALLMER @GMAIL.COM BOB.FELLER @ICONICACREATES.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0706-242-8001-5 TOWN OF VERMONT 24 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9661 HOWERY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> A-2 Agriculture 392574 Description:RESIDENTIAL ADDITION OVER EXISTING <br /> District IMPERVIOUS AREA , S' <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 5009 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES 0 NO 0 YES NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft. Sq.Ft. <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 36.5 UNNAMED 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 C.+.. +' <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / `.4111W/7 �o--/,�..a 076 <br /> OFFICE I;SE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/05/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />