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DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page 1 oft <br /> DCPSHL-2021-00078 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> !TRAVIS W MOODY (608) 239-2705 JOSHUA STEINHOFF (608) 457-2244 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4851 MORRIS CT 9216 N SERNS RD <br /> (City,State.Zip) (City,State.Zip) <br /> WAUNAKEE, WI 53597 MILTON, WI 53563 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TRAVIS@REDSTARTPICTURES.COM JOSH@JGSCONTRACTING.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0809-333-1256-0 TOWN OF WESTPORT 33 SW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4851 MORRIS CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 3 CSM 10962 <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> 6936 Description:REPLACEMENT OF EXISTING IMPERVIOUS <br /> SURFACE(DECK) <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES 2 NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> © YES ❑ NO ❑ YES 0 NO YES 2 NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft.300 Sq.Ft.300 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 280 LAKE MENDOTA PERMIT FEE <br /> $150.00 <br /> II, 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: • • -r/Age DAT : <br /> Ordinances.Any unauthorized change from the information orZ — \ <br /> plans submitted will invalidate the permit. !� <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/21/2021 HJ H3 <br /> DATE REVIEWED INITIALS <br />