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DANE COUNTY SHORELAND ZONING PERMIT ZONING 2017 0. Page 1 oft <br /> DCPSHL-2017-00048 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> BRIAN J MONSON (608)334-2867 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3102 MUIR FIELD RD <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53719 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> K8MONSON1 @GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 114 114 1/4 <br /> 0608-062-8400-0 TOWN OF VERONA 6 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3185 TIMBER LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12966 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> RH-1 Rural Homes 48667 Description:TEARDOWN REBUILD SFR :=1;; ;:iillii:i:;::::::iii;;;,7 <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic *:.=.2-:-:::.:,' <br /> . <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION ` <br /> 10198 t <br /> YES ® NO ,,'� <br /> SHORELAND FLOOD ZONE WETLAND ,,: a' ' <br /> ® YES 0 NO 0 YES ) NO 0 YES ® NO S 4 � <br /> Existing Impervious Proposed Impervious likE0 ,,,fir,' <br /> Sq.Ft.4838 Sq.FL 5679 t._ r� r <br /> Setback from Ordinary High Water Mark Water Body Name 1:7 ;,, `� <br /> 235 UNNAMED % 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 r'°+ 4 �,i � ,s $ <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. .. <br /> JIJ i7 <br /> ;'„ 1 I <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/11/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />