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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DC PS H L-2017-00029 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOEL BROWN <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2834 LAKEWOOD CIR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JOEL.R.BROWN @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0611-072-9980-6 TOWN OF PLEASANT SPRINGS 7 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2834 LAKEWOOD CIR <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 /> A-1 Ex Exclusive Ag 19340 Description:RESIDENTIAL ACCESSORY BUILDING 30 X 40 <br /> District <br /> PROJECT INFORMATION App fora Residential Structure; SEWER • <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES ® NO , yj24 <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES ❑ NO 0 YES ® NO 0 YES ® NO <br /> i e <br /> Existing Impervious Proposed Impervious ( q y <br /> Sq.Ft.O Sq.Ft. 1200 ,yam <br /> Setback from Ordinary High Water Mark Water Body Names Orlkit <br /> e <br /> 233 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 <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 <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. / i 6.73t 7017" <br /> OFFICE US_ONLY (form version 01.01.00) <br /> DATE ISSUED I IALS INSPECTION DATE INITIALS <br /> 05/04/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />