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DANE COUNTY SHORELAND ZONING PERMIT DZONING CPSHL-2016-00086 <br /> -2016 NO. Pagelof2 <br /> DCPSHL-2016-00086 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> KALLIE &VERN STENMAN QUERCUS LAND STEWARDSHIP (608)630-4493 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3363 FISH CAMP RD 4681 COUNTY HIGHWAY JJ <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53703 BLACK EARTH, WI 53515 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> VERN @MALLARDSBASEBALL.COM OFFICE @QUERCUS-LS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-133-8560-4 TOWN OF DUNN 13 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3363 FISH CAMP RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> R-3 Residence 144507 Description:SFR,FILLING OF FLOODPLAIN,ESTABLISHMENT <br /> District OF ACCESS AND VIEWING CORRIDORS FOR SHORELAND <br /> PROJECT INFORMATION App for a Residential Structure;App for Landscap SEWER <br /> ing;App for Other:ACCESS AND VIEWING CORRIDOR Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 363 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES ❑ NO ® YES ❑ NO ® YES ❑ NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.4194 Sq.Ft.6982 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 80.4 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 <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 Cou, ty zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SI f i <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. '101/j1� I <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 10/14/2016 HJH3 <br /> DATE REVIEWED INITIALS <br />