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DANE COUNTY SHORELAND ZONING PERMIT ZONING PER�1 NO. Page 1 of 2 <br /> DCPSHL-2018-00037 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> PAMELA S IVERS (608)235-5482 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5621 RANKIN LN <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE,WI 53597 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> pamelasg@charter.net <br /> PARCFL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0809-211-2249-8 TOWN OF WESTPORT 21 NE NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 5621 RANKIN LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 109 PLAT <br /> ZONING DISTRICT PARCEL SO FOOTAGE PROPOSED PROJECT: New Structure/Addition xa <br /> 26216 Description:8 x 12 storage shed t_ A x <br /> PROJECT INFORMATION App for a Residential Structure; SEWER J � rx _ " <br /> Sewer ,� <br /> REZONE NO C.U.P.NO VARIANCE NO DEED RESTRICTION '�, 4 aW <br /> ❑ YES (,a NO 4 4-, ," �'-: <br /> s <br /> SHORELAND FLOOD ZONE WETLAND • ta'., UK. l a, -ill r` - <br /> ® YES ❑ NO 0 YES ® NO YES ® NO c 5 �' " <br /> Existing Impervious Proposed Impervious ° s ' r` . <br /> sq.FL 3601 sq.R.3697 A '' �,/,. ,,, <br /> Setback from Ordinary High Water Mark Water Body Name '.x *'. sY* rr . ; z -a <br /> 150 Sixmile Creek r s'� '"} } - 4:PERMITFEE <br /> f Rte:y ; ~- $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 /> �-∎ <br /> Owner&Agent hereby agree to comply with all Dane County S a e ', �`" <br /> ��@tlf Q/�. . <br /> Ordinances.Any unauthorized change from the information or ` ° \ � /� <br /> plans submitted will invalidate the permits, t A , OZ t r <br /> USE ONLY (form version 02.00,00! <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/01/2018 HJH3 <br /> DATE REVIEWED INITIALS <br />