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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2017-00006 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRIAN E GIROUX (608) 833-5110 ROWE DESIGN AND CONSTRUCTION INC (608)225-8282 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5138 REYNOLDS AVE 7421 VOSS PKWY <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 MIDDLETON, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ROWE @ROWEDESIGNANDCONSTRUCTION.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0809-284-4241-5 TOWN OF WESTPORT 28 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME 1ST.TYPE <br /> (Assignment of new address is 5138 REYNOLDS AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 21 2 SECOND WARD BEACH, BLOCK 2 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> 13859 Description:SFR ADDITION <br /> PROJECT INFORMATION App for a Residential Structure; SEWER �� <br /> Sewer <br /> iiz r <br /> REZONE NO. C.U.P.NO. VARIANCE NO. <br /> DEED RESTRICTION e f <br /> ❑ YES ® NO <br /> SHORELAND x ' .� <br /> FLOOD ZONE WETLAND `' <br /> 1 F A--® YES ❑ NO ❑ YES ® NO ❑ YES ® NO z <br /> Existing Impervious Proposed Impervious VZ <br /> Sq.Ft 6094 Sq.Ft 6088 <br /> s d <br /> Setback from Ordinary High Water Mark Water Body Name <br /> =:Y <br /> 100 LAKE MENDOTA `` j 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 SIGNATURE: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. tovC"C GJ 4,,,r-, V/At h 7 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 02/20/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />