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-irerox aoout:Dian <br /> DANE COUNTY SHORELAND ZONING PERMIT ZONING PERMIT NO. Page lof2 <br /> DCPSH L-2020-00067 <br /> OWNER INFORMATION i AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MONTIG LIVING TR BRIAN HAGEY (608)628-8409 <br /> BILLING ADDRESS ADDRESS(Number.Street) <br /> 8237 • • TER 8237 EMERALD TER <br /> (City State,Zip) (City,State.Zip) <br /> LODI, LODI,WI 53555 <br /> e• E-MAIL ADDRESS <br /> BRIANHAGEY@OUTLOOK.COM <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-024-0501-4 TOWN OF ROXBURY 2 SE NE <br /> PROPERTY ADDRESS HOUSE NO ST DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 8237 EMERALD TER <br /> subject to field verification.) <br /> !LOT IBLOCK C.S.M.NO.or PLAT NAME <br /> 1 CRYSTAL LAKE ESTATES <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> SFR-08 Single 20812.74 Description:DETACHED RESIDENTIAL GARAGE 24X48 <br /> Family Residential <br /> PROJECT INFORMATION App for a Residential Structure: SEWER <br /> Septic <br /> REZONE NO. CUP.NO VARIANCE NO DEED RESTRICTION <br /> YES is NO <br /> SHORELAND FLOOD ZONE WETLAND <br /> YES D NO 0 YES ® NO ❑ YES ® NO <br /> Existing Impervious Proposed Impervious <br /> Sq.Ft Sq Ft.3519 <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 180 CRYSTAL LAKE PERMIT FEE <br /> S150.00 <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.usor 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:Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or ` .1 <br /> plans submitted will invalidate the permit. Yom. <br /> rf?� <br /> OFFICE USE ONLY (form version 02.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 07/21/2021 HJH3 <br /> DATE REVIEWED INITIALS <br /> 1 of 3 7/21/2021, 2:30 PI <br /> I <br />