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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO Page 1 of 2
<br /> DCPSHL-2018-00011
<br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION
<br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE
<br /> HENSEN BROS DAIRY INC HENSEN BUILDERS INC (608)849-4736
<br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street)
<br /> 5122 PHEASANT RD 110 BAKER ST SUITE B
<br /> (City,State,Zip) (City,State,Zip)
<br /> WAUNAKEE, WI 53597 WAUNAKEE,WI 53597
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> JHENSEN85 @YAHOO.COM HENSENBUILDERS @TDS.NET
<br /> PARCEL NO. TOWNSHIP SECTION 1/4 114114
<br /> 0808-254-8690-0 TOWN OF SPRINGFIELD 25 SE NW
<br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE
<br /> (Assignment of new address Is 5188 PHEASANT BRANCH RD
<br /> subject to field verification.)
<br /> LOT BLOCK C.S.M.NO.or PLAT NAME
<br /> 1 CSM 14721
<br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition '""' ��4=>' `�'::d:`: `' 'r=:
<br /> 49757 Description:TEARDOWN/REBUILD SFR '` .,,r $ �- �,, 14
<br /> . t 2a.H 4 (L R t t
<br /> PROJECT INFORMATION App fora Residential Structure: SEWER 4 - k ,` ;' 4.,,
<br /> Septic . i . Y 7
<br /> REZONE NO C.U.P.NO VARIANCE NO T �'�'i ` ; ': a
<br /> DEED RESTRICTION � }. ";,�r7�,�4-�p� .,,,�
<br /> ❑ YES ® NO rl r.'r ,3
<br /> SHORELAND FLOOD ZONE WETLAND 'i' `�p r., ,z1"- j "� ,, a
<br /> ® YES O NO [] YES ) NO [] YES 0 NO j''' y� ^v r r,-. �' K dl' s �:�?'E
<br /> r�'t+� � ,J �1 7y'}
<br /> ��.8}� r� �'r- A i"+. ... �fQ?`.-�� aRa" aZtixT9
<br /> Existing Impervious Proposed Im rvious i,'��:+���,4 1 MK In 's� j ip> ° {i c ty
<br /> g P Pe � <,a.,�`:„t>�.�.,��r � t s <� � i, .h � � '-tie�Y
<br /> ? a t f'.'_.: 'zs�` Ems"'X.��; as . °*-t
<br /> j :iyki �� iF� r 'eft t �� x T':•I t` s;n4, ,r: ,
<br /> Sq.Ft.4187 sq.Ft.972 4 ., 4 it p, -_' �' + �. J
<br /> Setback from Ordinary High Water Mark Water Body Name '.3'r;�", x� >''wkr ar 3 ' ,�.. k •`� z t 4• y.,.,. ,,,,-, ,x ..,�L+�Lfi'
<br /> 280 UNNAMED e.r- `�'-43,t,P��ii"`'`gt 400-4. .2t,-, -..;;.,.r: PERMITFEE
<br /> s; . y..,t 94:.,8 t"1 $150.00
<br /> 1, 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 1 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 SIG NAT_- EOwne�r/Age` ' DATA:;
<br /> Ordinances.Any unauthorized change from the Information or /''
<br /> plans submitted will Invalidate the permit. .. 3/02 3/��
<br /> Al"OFFICE USE ONLY (form version 02.00.00)
<br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS
<br /> 03/05/2018 HJH3
<br /> DATE REVIEWED INITIALS
<br />
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