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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT Page 1 of 2 <br /> DCPSHL-2017-00 063 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> RYAN F BAXTER CLASSIC CUSTOM HOMES OF WAUNAKEE (608) 850-4450 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4030 MANDAN CRESCENT 401 N CENTURY AVE <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53711 WAUNAKEE, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0709-053-2011-8 TOWN OF WESTPORT 5 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4717 COUNTY HIGHWAY M <br /> subject to field verification.) <br /> LOT BLOCK I C.S.M.NO.or PLAT NAME <br /> 1 FOX BLUFF,ASSESSOR'S PLAT <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> 43494 Description:TEARDOWN/REBUILD SFR <br /> PROJECT INFORMATION App fora Residential Structure; SEWER § , <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND r�"�i�� 9 <br /> ® YES ❑ NO fl YES ® NO El YES ® NO . <br /> Existing Impervious Proposed Impervious 1r4; <br /> Sq.Ft.8907 Sq.Ft.12986 <br /> Setback from Ordinary High Water Mark Water Body Name ��� �� <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 SIGNATU: : Owner/Agent DATE. <br /> Ordinances.Any unauthorized change from the information or / <br /> plans submitted will invalidate the permit. J - 9 • I <br /> OFFICE USE ONLY (form version 01.[1.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 08/31/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />