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DANE COUNTY SHORELAND ZONING PERMIT ZONING 0. Page 1 of2 <br /> DCPSHL-2018-00028 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> !BETHANY M HOWLETT DK BUILDERS (619)922-9646 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 9702 MCFEE RD 303 PANTHER TRL <br /> (City,State,Zip) (City,State,Zip) <br /> MOUNT HOREB, WI 53572 MONONA, WI 53716 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DAVIDK2ND @HOTMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0706-132-9790-0 TOWN OF VERMONT <br /> 13 NW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9702 MCFEE RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 12039 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building a V40; <br /> A-2 Agriculture Description:SECOND STORY ADDN TO SFR AND REMODEL `"r. <br /> District <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic a , <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 7238 ❑ YES ® NO a <br /> SHORELAND FLOOD ZONE WETLAND <br /> „® YES NO YES ® NO YES ® NO ' <br /> Existing Impervious Proposed Impervious a .' <br /> Sq.Ft. Sq.Ft. �� . <br /> p_ <br /> Setback from Ordinary High Water Mark Water Body Name „ r yr£ 4.. <br /> s <br /> VERMONT CREEK S ,, e � yPERMIT FEE 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 SIGNAT : : Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 6 . <br /> OFFICE USE ONLY (form version 02.00.00) <br /> DATE ISSUED I INITIALS INSPECTION DATE INITIALS <br /> 04/20/2018 HJH3 <br /> DATE REVIEWED INITIALS <br />