Laserfiche WebLink
a <br /> It NIFD,IgIiMII NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2018-00003 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> 'RICHARD H KRANZE MSA PROFESSIONAL SERVICES (608) 242-6603 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3423 STONE CREST RD 2901 INTERNATIONAL LN STE 300 <br /> (City State.Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rkranze @kranzetech,com esorensen @msa-ps.com <br /> F'ARGEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0610-133-9260-5 TOWN OF DUNN 13 SW SW <br /> PROPERLY ADDRESS HOUSE NO ST DIRECTION STREET NAME ST TYPE <br /> (Assignment of new address If 3423 STONEY CREST RD <br /> subject to field verification.) <br /> LOT ;BLOCK C S.M NO or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ I-OUTAGE PROPOSED PROJECT' New Structure/Addition <br /> R-3 Residence 13068 Description <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 /> D YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES D NO m YES p NO ® YES Li NO <br /> Existing Impervious Proposed Impervious <br /> Sq Ft Sq Ft. <br /> 'Setback`rpm Ordinary High Water Mark Water Body Name <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 8 Agent hereby agree to comply with all Dane County SIGNATURE;-• vher/Agent DATF: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. ! ti - <br /> OFFICE USE ONLY (form version 02.00.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 01/17/2018 SSA1 <br /> DATE REVIEWED INITIALS <br />