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DANE COUNTY SHORELAND ZONING PERMIT ZPERMIT NO. Page 1 oft <br /> DCPSHL-2PSHL-2021-00059 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN A BARRY (608) 358-0406 MOYERS INC (608)235-6741 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2934 TRACY LN 190 BUSINESS PARK CIRCLE <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> BAD.GER@HOTMAIL.COM MATT.HANNA@MOYERSINC.NET <br /> PARCEL NO, TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0611-304-1002-4 TOWN OF PLEASANT SPRINGS 30 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2934 TRACY LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 KEGONSA PARK SUBDIVISION <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> SFR-08 Single 22446 Description:RELOCATE PATIO <br /> Family Residential <br /> PROJECT INFORMATION App for Landscaping; SEWER <br /> Sewer <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> 0 YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> , <br /> ® YES 0 NO ii YES ® NO El YES ® NO az <br /> `,.z <br /> (Existing Impervious Proposed Impervious t <br /> Sq.Ft.1386 Sq.Ft.1012 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 80 LAKE KEGONSA , . 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 SIGNATURE: Own--/•� ,nt DATE: il4 al <br /> j <br /> Ordinances.Any unauthorized change from the information or '/) / (/ <br /> plans submitted will invalidate the permit. CY <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/16/2021 HJH3 <br /> DATE REVIEWED INITIALS <br />