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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2020-00099 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAYSON JONES (608)825-9788 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5337 REINER RD <br /> (City State.Zip) (City,State,Zip) <br /> MADISON, WI 53718 <br /> E-MAIL ADDRESSE-MAIL ADDRESS <br /> JJONES@BURKETRUCK.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 23 SE SE <br /> 0810-234-9520-4 TOWN OF BURKE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5337 REINER RD <br /> subject to field verification.) <br /> LOT (BLOCK C.S.M.NO.or PLAT NAME <br /> Il METES AND BOUNDS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT. New Structure/Addition <br /> HC Heavy 205730 Description:REPLACEMENT COMMERCIAL BUILDING <br /> Commercial District <br /> PROJECT INFORMATION App for Commercial Structure;App for Relocating I SEWER <br /> Septic <br /> mpervious Surfaces: `. <br /> REZONE NO. C.U,P.NO. VARIANCE NO. DEED RESTRICTION s ..';.w> <br /> 0 YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND a <br /> ® YES ID NO El YES ® NO 0 YES ® NO § <br /> Existing Impervious Proposed Impervious x <br /> Sq.Ft 1258 Sq.Ft. 1258 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 270 UNNAMED 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 oning inspectors for the <br /> purposes of determining compliance with the zoning ordinance <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATU- . • •n:1 • • ' DATE: <br /> Ordinances.Any unauthorized change from the information or , / AT‘E:-7-a2/ <br /> j <br /> plans submitted will invalidate the permit. <br /> OFFICE USS ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 06/07/2021 HJH3 <br /> DATE REVIEWED INITIALS <br />