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DANE COUNTY SHORELAND ZONING PERMIT ZONING- Page 1 of 2 <br /> DCPSHL-2017-00030 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JENNIFER KOBRYN (608) 393-0808 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2071 RIVER ESTATES LN <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JZLOTOCHA @YAHOO.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-291-8415-7 TOWN OF PLEASANT SPRINGS <br /> 29 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2071 RIVER ESTATES 1 LN <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building ? <br /> R-1 Residence 68968 Description:REPLACE EXISTING DECK AND DECK ADDITION i. y <br /> District x <br /> PROJECT INFORMATION App for a Residential Structure; SEWER , pp � `. <br /> Septic <br /> . <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ; z 4. -;,- �,', <br /> � ln G <br /> 1390 YES ® NO <br /> •' FLOOD ZONE WETLAND r a»: , <br /> 0 YES 0 NO 0 YES ® NO 0 YES ® NO <br /> ` - � - , <br /> Existing Impervious Proposed Impervious ,,,2:-'' _ � �: � <br /> Sq.Ft.4070 Sq.Ft.4462 <br /> Setback from Ordinary High Water Mark Water Body Name - ',,;‘:".. -`,7- <br /> -4 ,' 's, <br /> 232 YAHARA RIVER i4PERMIT 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 SI NATURE: Owner/; !ent ATE: <br /> Ordinances.Any unauthorized change from the information or "/�\j s / <br /> plans submitted will invalidate the permit. �IN/ �`c/1 7 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 05/05/2017 HJ H 3 <br /> DATE REVIEWED INITIALS <br />