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ZONING PERMIT 0 Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT <br /> DCPSHL-2021-00041 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> (JEFFREY C NEWMAN (608) 516-7939 EMMONS AND OLIVIER RESOURCES,INC (608) 839-6206 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4288 JORDAN DR 119 S MAIN ST <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 COTTAGE GROVE, WI 53527 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JKNEWMAN@CHARTER.NET NHAYDEN@EORINC.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0610-084-5127-0 TOWN OF DUNN 8 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4288 JORDAN DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 15553 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> SFR-08 Single 19369 Description:RESIDENTIAL ADDITION <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 /> O YES ® NO • <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES 0 NO ❑ YES ® NO ❑ YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.7269 Sq.Ft.6779 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 78.4 LAKE WAUBESA 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.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 SIGNAT • -r/A•e l DA <br /> Ordplans nces.submitted <br /> Any unauthorizedidatthe e <br /> from the information or - , 4_7- —s' 6 7 2- <br /> plans submitted will Invalidate the permit. <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/07/2021 HJH3 <br /> DATE REVIEWED INITIALS <br />