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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Pagel oft <br /> DCPSHL-2017-00010 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BAUMBACH LIVING TR,SCOTT C&KELLY L ACKER BUILDERS (608)850-6650 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 609 WORTINGTON DR 331 E MAIL ST <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597 WAUNAKEE, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JENNY.ACKER @ACKERBUILDERS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1141/4 <br /> 0809-281-9810-9 TOWN OF WESTPORT 28 NE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5583 KU PFER RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT I PARCEL SC)FOOTAGE PROPOSED PROJECT: Alteration to existing building x;� <br /> 34200 Description:SFR <br /> PROJECT INFORMATION ApP a <br /> for a Residential Structure; SEWER f�; <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. ,. <br /> DEED RESTRICTION 4 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE •WETLAND <br /> ® YES 0 NO El YES j NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.0 Sq.FL 8710 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 76 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 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 c < .2.1 ` ; <br /> Ordinances.Any unauthorized change from the information or r_ <br /> plans submitted will invalidate the permit. jar f *-4011F &`)(/- <br /> OFFICE U&:UNLY (form version 01.01 00) <br /> DATE ISSUED INITIALS I.', INSPECTION DATE INITIALS <br /> 03/02/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />