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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2017-00008 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> DENISE M LEHNER (608) 558-2526 HANDYMAN TONY (608) 213-4735 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1475 DILL DR 1353 RUTLEDGE ST <br /> (City,State,Zip) (City,State,Zip) <br /> BROWNTOWN, WI 53522 MADISON, WI 53703 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HAN DYMANTO NY @G MAI L.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0610-172-0019-9 TOWN OF DUNN 17 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4378 JORDAN DR <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 10 WATERCRESS PARK CONDOMINIUM ASSOCIATION INC <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition �- ",.. ' <br /> R-4 Residence 1327.2 Description REMOVE NON-CONFORMING SHORELAND Y - ` .' <br /> RESIDENCE AND BUILD NEW OUTSIDE OF EXISTING Nip <br /> District ���r--- x .: rr <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION �r 'f <br /> 4809 .' �; <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND 4 f " '°` <br /> ® YES ❑ NO 0 YES ® NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious ' kt <br /> Sq.Ft.650 Sq.Ft.752 �� - 1 <br /> a <br /> Setback from Ordinary High Water Mark Water Body Name Rt <br /> 24.8 LAKE WAUBESA - t t, PERMIT FEE <br /> s $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 SIGNAT - :'Owner/Age DATE: <br /> Ordinances.Any unauthorized change from the information or / 26 AV plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form vers'.on 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 02/27/2017 HJ H 3 <br /> DATE REVIEWED INITIALS <br />