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DANE COUNTY SHORELAND ZONING PERMIT ZCPSHL 2018 NO. Page 1 oft <br /> DCPSHL-2018-00004 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> !HAPPY VALLEY ADDITION LLC (608) 220-1211 HART DENOBLE BUILDERS (608) 831-4422 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3564 EGRE RD 7923 AIRPORT RD <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 MIDDLETON, WI 53562 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CHADSCOTT @FIRSTWEBER.COM HART @DENOBLEBUILDERS.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-302-0496-0 TOWN OF BRISTOL <br /> 30 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 26 HAPPY VALLEY ADDN TO BRISTOL GARDENS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> 34784 Description:sfr <br /> A for a <br /> Residential Structure; SEWER ; ` *� <br /> PROJECT INFORMATION PP ���s� a �� <br /> Septic . , ,. <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION * + * g1e`r <br /> ' . <br /> . ? ,,,_„ , , <br /> 0 YES ® NO {^W <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES 0 NO ❑ YES ® NO M] YES ® NO �� r r.,' v � �' <br /> ] A k <br /> Existing Impervious Proposed Impervious 4 <br /> Sq.Ft.0 Sq.Ft.<15% <br /> v,ti-x t..$(iii ,, »":4, 4 S t'1,7?-7 s' <br /> Setback from Ordinary High Water Mark Water Body Name ';'-'4'f'-'''' y, p- ._ . ._ <br /> 280 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 perf ormed, 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 8 Agent hereby agree to comply with all Dane County SIGNATUR Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or n <br /> plans submitted will invalidate the permit. �•4 Z3-20/O <br /> OFFICE USE ONLY (form version 02.00.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 01/23/2018 HJH3 <br /> DATE REVIEWED INITIALS <br />