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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page l of 2 <br /> DCPSHL-2021-00030 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBERT S KREGER (608)206-3751 SUDBURY CONSULTANTS (608) 358-3556 <br /> BILLING ADDRESS(Number,Street)„„ ADDRESS(Number,Street) <br /> 3 7a sro'cz a, 5114 SUDBURY WAY <br /> (City,State,Zip) (City,State,Zip) <br /> C f "Iwo 5355 g MADISON, WI 53714 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ROB.KREGER@GMAIL.COM SUDBURYCONSULTANTS@GMAIL.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-291-0634-8 TOWN OF PLEASANT SPRINGS 29 NE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2076 YAHARA DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 4 SQUIRE'S ROLLING MEADOWS- <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition • <br /> SFR-08 Single 29275 Description:SINGLE FAMILY RESIDENCE <br /> Family Residential <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES 0 NO ❑ YES 0 NO YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.0 Sq.Ft.6740 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 125 YAHARA RIVER 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.usor 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 SIGN TU r E: Ow er/Agent DAT : <br /> Ordinances.Any unauthorized change from the information or . / j <br /> plans submitted will invalidate the permit. f(� <br /> t / /Z/ <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/11/2021 HJ H3 <br /> DATE REVIEWED INITIALS <br />