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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2016-00006 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> AMANDA A MCFARLANE (608) 963-2384 ZACH LENERZ (608) 393-3601 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 7377 CEDAR CREST DR 205 13TH AVE <br /> (City,State,Zip) (City,State,Zip) <br /> SAUK CITY, WI 53583 BARABOO, WI 53913 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ZLENERZ @HOTMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0907-184-3012-0 TOWN OF ROXBURY 18 SE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7295 FLYHAWK LN <br /> subject to field verification.) <br /> LOT 'BLOCK C.S.M.NO.or PLAT NAME <br /> 2 BLACKHAWK FIELDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-1 Residence 39186 Description;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 /> 9814 <br /> D YES ID NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES 0 NO U YES ® NO 0 YES ® NO <br /> Edsting Impervious Proposed Impervious <br /> Sq.Ft. 1364 Sq.Ft.5600 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 150 ROXBURY CREEK 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 SIG. ATURE: wner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. y' <br /> OFFICE OF E ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 03/09/2016 HJ H 3 <br /> DATE REVIEWED INITIALS <br />