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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2016-00077 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> TREE HOLLOW LLC SCOTT&MONICA FINLEY (608) 520-0028 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2751 TOWER RD 320 W BROADWAY#224 <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND,WI 53558 MONONA,WI 53716 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SRFINLEY @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-093-0148-9 TOWN OF DUNN <br /> 9 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2755 TOWER RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 28 1 GREENRIDGE PARK <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-3 Residence 9542 Description:SFR <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> 0 YES ❑ NO YES ® NO ❑ YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.485 Sq.Ft.3667 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 91.9 LAKE WAUBESA 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 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 Resour es Service Center. <br /> I hereby consent to the entry on the permitted premises by D. - ' ounty zoning inspectors for the <br /> purposes of determining compliance with the zonin• . i'na, - <br /> Owner&Agent hereby agree to comply with all Dane County -'• er/Agent DAT <br /> information Ordisances.Any unauthorized change from the information o' i�/ �1 /�■ <br /> plans submitted will invalidate the permit. / <br /> fir OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 09/20/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />