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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2016-00080 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> REISELL LLC(Craig and Julie Reisdorf) (608)219-4737 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1719 REISELL RD <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JREIZY @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0606-324-9175-0 TOWN OF BLUE MOUNDS 32 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 10649 MAYFLOWER RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14330 <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> RH-1 Rural Homes 84574 Description:SFR <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER 4' <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION 4,a, .,, 1 <br /> 10997 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND A ,, ,,, f, a f <br /> ® YES 0 NO El YES 0 NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.0 Sq.Ft.6453 _° If ' 3v <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 170 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 zo '•g ordinances. T <br /> Owner&Agent hereby agree to comply with all Dane County ., ` E: Ow (Agent DATE. <br /> Ordinances.Any unauthorized change from the information or � �/ !„plans submitted will invalidate the permit. / <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED 1r ITIALS INSPECTION DATE INITIALS <br /> 09/29/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />