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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2017-00092 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JEREMY B MCCUE ZIEGLER BUILDERS (608) 576-7257 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 334 GLENWAY ST 1102 WOODBRIDGE TRL <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53705 WAUNAKEE, WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JZIG @TDS.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-144-7621-9 TOWN OF DUNN 14 SE SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2424 COUNTY HIGHWAY AB <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 11 PIKE FRONT <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> R-3 Residence Description:2 EGRESS WINDOWS <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES 0 NO p YES ® NO � YES ® NO ��� � • <br /> Existing Impervious Proposed Impervious <br /> � ✓ <br /> Sq.Ft. Sq.Ft. �' fi r <br /> .,u�� �ti "` � � u r <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 55 LAKE KEGONSA <br /> 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 SIGNATUR : •wnet Ag/'t DATE: <br /> Ordinances.Any unauthorized change from the information or f -7 <br /> plans submitted will invalidate the permit. , , f /6)- / 9 ` <br /> OFFICE USE ONLY �� (form version 01.01.00) <br />• <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 12/13/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />