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DANE COUNTY SHORELAND ZONING PERMIT C H 2018 00. Page l of <br /> DPSL-2018-00046 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MADISON METROPOLITAN SEWERAGE DANE COUNTY PARKS (608)221-7212 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 1610 MOORLAND RD 5201 FEN OAK DRIVE <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53713 MADISON, WI 53718 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DESMIPT.ALEX @COUNTYOFDANE.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0710-304-9000-0 TOWN OF BLOOMING GROVE 30 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7300 SOUTH TOWNE RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: , <br /> M-1 Industrial District Description:CAPITAL CITY TRAIL RESURFACING . .1 A <br /> 04005011110,41W <br /> PROJECT INFORMATION App for Other:REGIONAL TRAIL SEWER ' ', <br /> Se tic S; _ �� a�� g . <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> � � <br /> _� <br /> � . it❑ YES ® NO Y <br /> L <br /> ? i S � .r ' ti.. dY' i <br /> SHORELAND FLOOD ZONE WETLAND !, <br /> a <br /> ® YES 0 NO EI YES ® NO ❑ YES ® NO ,, k K tom; <br /> Existing Impervious Proposed Impervious 77 &' 4V1 L <br /> Sq.Ft. Sq.Ft. r * titijf ii t -i r <br /> Setback from Ordinary High Water Mark Water Body Name ' sr+ k ,r A a ` , <br /> . r n`l { l�q PERMITFEE <br /> l x fi �� 0fte $0.00 <br /> � ;a se.7Md' <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 $1 . ;' ! '. 'PATE, <br /> Ordinances.Any unauthorized change from the Information or . / <br /> plans submitted will invalidate the permit. `�=Of� b I e7 (5 <br /> OFFICE USE ONLY (form version 02.J0.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/18/2018 HJH3 <br /> DATE REVIEWED INITIALS <br />