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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2015-00070 <br /> OWNER INFORMATION I AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LINK TR, CULLEN VITO (630)543-3010 QUAM ENGINEERING, LLC (608)838-7750 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3038 SHADYSIDE DR 4604 SIGGELKOW RD SUITE A <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 MCFARLAND, WI 53558 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SJINK502 @AOL.COM RQUAM @QUAMENGINEERING.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-304-4023-3 TOWN OF PLEASANT SPRINGS 30 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3038 SHADYSIDE 1 DR <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 3 CRYSTAL SPRINGS PARK <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building `_ r - z , <br /> R-3 Residence 11143 Description:SFR ADDITION AND INSTALLATION OF OPEN . <br /> District GRATE RAMP+CONVERT GRAVEL DRIVEWAY TO �'. * <br /> nrl\Irnnnrn nnnnn T.Ill,[•TArsil 17r1-1 <br /> PROJECT INFORMATION App for a Residential Structure;App for Walkway/ SEWER <br /> Stairs;App for Relocating Impervious Surfaces; Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND 'tom€ ` k x `3 <br /> �rsta fib' � 5�t F _ <br /> ® YES 0 NO 0 YES ® NO ❑ YES I� NO t, .� e.' s . -,,, . <br /> Existing Impervious Proposed Impervious Ztu; t." - :.-d. <br /> Sq.Ft.4266 Sq.Ft.3974 <br /> Setback from Ordinary High Water Mark Water Body Name , 1"s <br /> 79 LAKE KEGONSA x.4 , . T . PERMIT FEE <br /> $150.00 <br /> I, the undersigned, afm 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 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 SIGNAT,��E: • --N .1. t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. J% u L 5_2.9.-i , <br /> C;rICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/27/2015 HJH3 <br /> DATE REVIEWED INITIALS <br />