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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2016-00090 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> CISLER LIVING TR (608)835-7705 ROB MONTGOMERY (608) <br /> (608)839-4422 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3051 SHAW CT 119 S MAIN ST <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53711 COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS <br /> JIM.CISLER @FRONTIER.COM E-MAIL ADDRESS <br /> ROB @MA—RS.ORG <br /> PARCEL NO. TOWNSHIP SECTION 1/4 <br /> 0610-051-4474-6 5 1/4 1/4 <br /> TOWN OF DUNN NE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME <br /> ST.TYPE <br /> (Assignment of new address is 3051 SHAW CT <br /> subject to field verification.) <br /> LOT (BLOCK I C.S.M.NO.or PLAT NAME <br /> B WAUCHEETA <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: Alteration to existing building I <br /> R-2 Residence 15803 Description:ADDITIONS TO SFR <br /> District �� , <br /> PROJECT INFORMATION App for a Residential Structure; ; <br /> SEWER <br /> I Sewer �'� /�' <br /> REZONE NO. C.U.P.NO. VARIANCE NO. 0 x� <br /> DEED RESTRICTION � <br /> ❑ YES ® NO V .:*'-'4-:-., ; <br /> SHORELAND FLOOD ZONE WETLAND t j . a <br /> ® YES ❑ NO ❑ YES ® NO 0 YES ® NO x � <br /> / a <br /> Existing Impervious Proposed Impervious y# <br /> Sq.Ft.1725.2 y : y �a <br /> Sq.Ft.2973 - <br /> Setback from Ordinary High Water Mark Water Body Name :0,44, � <br /> 160 LAKE WAUBESA " , ,0 PERMIT'F''-E-a <br /> EE <br /> .1E.„ x . v $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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or 1 plans submitted will invalidate the permit. �� <br /> f ''( 7- l <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 11/02/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />