Laserfiche WebLink
ZONING PERMIT NO Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2017-00023 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> LEONA LE LUKE LE <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5237 THORSON RD 5237 THORSON RD <br /> (City,State,Zip) (City,State,Zip) <br /> SUN PRAIRIE, WI 53590 SUN PRAIRIE,WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LLE6462 @GMAIL.COM <br /> PARCEL NO TOWNSHIP SECTION 1/4 1/41/4 <br /> 0810-252-8280-0 TOWN OF BURKE 25 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5327 THORSON RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 13780 <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> A-1 Agriculture 89152 Description:GRAVEL DRIVEWAY AND GRAVEL PAD FOR <br /> District GARAGE <br /> PROJECT INFORMATION App for a Residential Structure;App for Other.D SEWER <br /> RIVEWAY Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES 0 NO 0 YES ® NO YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.4500 Sq.Ft.4500 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 75 UNNAMED 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 $ •, • • edAgent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. Ape / <br /> OFFICE USE O .LY (form version 01.01.00) <br /> DATE ISSUED ITIALS INSPECTION DATE INITIALS <br /> 04/13/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />