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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2017-00024 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> NICOLE JAMES PROPERTIES LLC (303)475-7400 HOUSE DOCTORS M.D. INC. 608576 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2938 WAUBESA AVE 48624 MORSE RD <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53711 POYNETTE, WI 53955 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MFOUNTAIN @HOUSEDOCTORS.MD.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-053-7111-6 TOWN OF DUNN 5 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2936 WAUBESA AVE <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 11 3 WAUBESA BEACH-2ND ADDITION <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition `#- <br /> R-3 Residence 8920 Description:TEARDOWN REBUILD SFR <br /> District <br /> PROJECT INFORMATION App for a Residential Structure;App for Landscap SEWER <br /> ing;App for Walkway/Stairs; <br /> Sewer ' " <br /> ; <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND w ` <br /> Peep. nos <br /> YES NO YES ® NO El YES ® NO . <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.2715 Sq.Ft.3715 44 /14' <br /> Setback from Ordinary High Water Mark Water Body Name , µ � t <br /> 59.85 LAKE WAUBESA ri ° n' t' 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 _ .,••■ 4 • • DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. P`1,-e7 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 04/17/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />