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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT . DCPSHL-2018-000o7 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> 'MICHAEL HOCKING (815)481-1368 TODD BARNETT (608)266-4538 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4964 HICKORY TRL 118 N BREESE TERRACE SUITE 1 <br /> (City,State,Zip) (City,State,Zip) <br /> MIDDLETON, WI 53562 MADISON, WI 53726 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MRHOCKING @GMAIL.COM TODD @BARNETTARCHITECTURE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0808-313-6203-3 TOWN OF SPRINGFIELD <br /> 31 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4964 HICKORY TRL <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 ENCHANTED VALLEY <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> 70245 Description:ADDITION TO SFR <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic • <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND ¢i f <br /> YES El NO 0 YES ® NO 0 YES ® NO F <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.5289 Sq.Ft.5457 <br /> Setback from Ordinary High Water Mark Water Body Name 4 <br /> PERMIT FEE <br /> 145 UNNAMEDn - <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 SIGNAT - " `e ner/Agent DATE: � <br /> Ordinances.Any unauthorized change from the information or / /�/� / <br /> plans submitted will invalidate the permit. //I <br /> OFFICE USE ONLY (form version 02.00.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 02/06/2018 HJH3 <br /> DATE REVIEWED INITIALS <br />