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ERMIT <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2021 ZONING 2021 00. Page 1 of <br /> -00079 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> !DONNA R ANDERSON (608) 215-1614 CHAMPION WINDOW COMPANY OF MILWAUKEE LLC (984) 224-7926 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 2088 BARBER DR 16560 W GLENDALE DR <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WI 53589 NEW BERLIN, WI 53151 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DANDERSON0329@HOTMAIL.COM KALSTON@CHAMPIONWINDOW.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0610-262-0264-3 TOWN OF DUNN 26 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 2088 BARBER DR <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 14 LINCOLN PARK <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: Alteration to existing building <br /> SFR-08 Single 8916 Description:3-SEASON ROOM OVER EXISTING PATIO <br /> Family Residential <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> ® YES O NO YES CO NO YES ® NO <br /> 1 _ <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft. 135 Sq.Ft. 135 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 79 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 SIGNA URE: Owner/AgentDATE: <br /> Ordinances.Any unauthorized change from the information or /'I ZZ 2_ I/ <br /> plans submitted will invalidate the permit. i <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/22/2021 HJH3 <br /> DATE REVIEWED INITIALS <br />