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DANE COUNTY SHORELAND ZONING PERMIT ZCPSHL- 017 00. Pagel of2 <br /> DCPSHL-2017-00050 <br /> OWNER INFORMATION � AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BLAKE J FRITZ (608)334-2422 MOYER'S INC (608)235-6741 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3254 BROOKLYN DR 936 STARR SCHOOL RD <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 STOUGHTON,WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> FRITZD@EVENSVILLE.K12.WI.US MATT.HANNA @MOYERSINC.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0610-254-4066-5 TOWN OF DUNN 25 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3254 BROOKLYN DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 6 CAMP COLUMBIA <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building ' a <br /> R-3 Residence Description:REPLACE EXISTING DECK WITH NEW BLOCK AND "` <br /> District GRAVEL PATIO IN SAME FOOTPRINT(PORTION OF DECK TO 2 aO <br /> ocI.AAIAn .4 q- -p'h , y «419 <br /> PROJECT INFORMATION App for a Residential Structure; SEWER kid 1�* <br /> Sewer �;: -f , <br /> REZONE NO. C.U.P.NO. VARIANCE NO. a ' �a <br /> DEED RESTRICTION - <br /> U YES ® NO 4 <br /> � : � a - <br /> � <br /> . <br /> SHORELAND FLOOD ZONE WETLAND ,� : r5 <br /> ® YES 0 NO ❑ YES ® NO ❑ YES ® NO " 4` ' N £ <br /> Existing Impervious Proposed Impervious a Z s r- n <br /> Sq.Ft.288 sq.Ft.288 eA , _ - ; N",„051 <br /> 1 <br /> Setback from Ordinary High Water Mark Water Body Name ,xs.- s ,` `_ : a. <br /> 60 LAKE KEGONSA .- ��f°PERMIT FEE <br /> �� i .,.,_.__. $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 SIGNATUR Oir/Agent DAT : <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. <br /> ii,..arai /7 iZ 7 <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/12/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />