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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 of2 DCPSHL-2018-00029 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE (LAKE KEGONSA LLC (630)710-3040 CONCRETE RESULTS LLC (608)434-6138 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 720 S GUNDERSON 7210 BRANFORD LANE EAST (City,State,Zip) (City,State,Zip) OAK PARK, IL 60304 MADISON, WI 53717 E-MAIL ADDRESS E-MAIL ADDRESS CONCRETERESULTSLLC @GMAIL.COM PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0611-191-5194-2 TOWN OF PLEASANT SPRINGS 19 NE SW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 2307 WILLIAMS POINT DR subject to field verification.) LOT 'BLOCK C.S.M.NO.or PLAT NAME 44 WILLIAM'S POINT- ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building Residence Description:REPLACE EXISTING TIMBER RETAINING WALL District WITH CONCRETE BLOCK PROJECT INFORMATION App for Relocating Impervious Surfaces;App for Ot SEWER her:RETAINING WALL Sewer REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION 336 (] YES ® NO SHORELAND FLOOD ZONE WETLAND ® YES D NO ❑ YES ® NO ❑ YES ® NO Existing Impervious Proposed Impervious Sq.Ft. Sq.Ft. Setback from Ordinary High Water Mark Water Body Name � 'M V h ,., � � 41.t l 140 LAKE KEGONSA PERMIT FEE $150.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGN ' • -r/Agent DAT : Ordinances.Any unauthorized change from the information or y� o �� plans submitted will invalidate the permit. OFFICE USE ONLY (form version 02.00.00) DATE ISSUED INITIALS INSPECTION DATE INITIALS 04/26/2018 HJH3 DATE REVIEWED INITIALS