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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT 0. Page, of 2 <br /> DCPSHL-2016-00088 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> WYST59 LLC (608)445-9692 MSA PROFESSIONAL SERVICES (608) 242-6603 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6959 RIVER RD 2901 INTERNATIONAL LN SUITE 300 <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TYLER @MADISONBLOCKANDSTONE.COM ESORENSEN @MSA-PS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0909-251-9920-0 TOWN OF VIENNA 25 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6959 RIVER RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO,or PLAT NAME <br /> 1 CSM 03585 <br /> ZONING DISTRICT P RCEL SO FOOTAGE PROPOSED PROJECT: " <br /> 78408 Description:CONVERSION OF COMMERCIAL SITE TO DAY ;; :j.,, <br /> CARE FACILITY + �, s <br /> PROJECT INFORMATION App for Relocating Impervious Surfaces; SEWER \, , $ P <br /> Septic ., , <br /> 2- : 362 Z.eN2t. x <br /> REZONE NO. C,U.P.NO. VARIANCE NO. DEED RESTRICTION ,x ; <br /> 0 YES ® NO i; <br /> 3 <br /> SHORELAND FLOOD ZONE WETLAND '\;r sa <br /> ® YES ❑ NO 9 YES ® NO 0 YES ® NO 0.. R i w, , _.. <br /> Existing Impervious Proposed Impervious � a\ f� � � <br /> Sq.FL 38780 Sq.Ft.30260 ; 'A'�� x <br /> y <br /> AZM '\ 5 Ate. ...,,x, iA<: b\\�`'$ ar P <br /> Setback from Ordinary High Water Mark Water Body Name <br /> O'':‘,„. ,' A < <br /> 106 YAHARA RIVER ' � 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 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 SIGNA •-i w r/Agent (q1L � <br /> , � DATE: <br /> Ordinances.Any unauthorized change from the information or d - <br /> plans submitted will invalidate the permit. - 1112,3/ 16 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 10/24/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />