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DCPSHL-2017-00033
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DCPSHL-2017-00033
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6/29/2017 1:19:00 PM
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DCPSHL-2017-00033
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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of 2 <br /> DCPSHL-2017-00033 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> THOMPSON 2017 LIVING TR,THOMAS&NANETTE (608) 963-1005 SCOTT POULSEN (608)444-0419 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4990 BORCHERS BEACH RD 4860 PING SPRING RD <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 DEFOREST, WI 53532 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> NANTHOMPSON @GMAIL.COM SCOTT @POULSENINC.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0809-332-7198-4 TOWN OF WESTPORT 33 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4990 BORCHER'S BEACH RD <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 18 BORCHER'S BEACH <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> 17761 Description:ADDN TO SFR OVER EXISTING IMPERVIOUS , <br /> SURFACES K, - = <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Sewer , <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION x <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND . - <br /> ® YES ❑ NO 0 YES ® NO 0 YES 0 NO '' % ' <br /> Existing Impervious Proposed Impervious r 43 <br /> + EA & .4 <br /> Sq.Ft. Sq.Ft.242 b ," -A._ ,,,' . <br /> Setback from Ordinary High Water Mark Water Body Name s , <br /> w , <br /> LAKE MENDOTA 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 SIG)ATURE: O er/A ent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. e: I / j -/ 7 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 05/24/2017 HJ H 3 <br /> DATE REVIEWED INITIALS <br />
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