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Dane County Shorelan s Zoning zoning* cerrseowyA <br /> Permit Application ShorelandPexmrt DCPSHL- <br /> Application must be made in person Zoning Permit11 DCPZP <br /> Shoreland Zoning Permit fee is$150 <br /> A shoreland zoning Permit will be required p for to a general zoning permit being issued by the Dane County <br /> Zoning Division for any development within t e shoreland district. <br /> Property Owner Information Agent Information <br /> Name Agent Name <br /> Dane County Parks Darren Marsh <br /> Address Agent Address <br /> 5201 Fen Oak Drive 5201 Fen Oak Drive <br /> City,State,Zip City,State,Zip <br /> Madison, WI 53718 Madison, WI 53718 <br /> Phone Agent Phone <br /> (608)224-3766 (608)240-3766 <br /> E-Mail Agent E-mail <br /> marsh @countyofdane.c.m marsh @countyofdane.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Acreage <br /> a ""v49yRd 09N r 7E 21 <br /> a To Section % NW NW Less than 1 <br /> Parcel Number(s)090721285832 Zoning District RE-1 <br /> CSM Lot •ubdivision Block/Lot <br /> Project Description <br /> Dane County Parks is proposing to remove an erdsdng,unsafe,wood and replace it with a new steel beam with wood deck bridge on that measures 12'wide by 40'long. <br /> Please answer the following questions to t e best of your ability: <br /> Is the property within 300 feet of a stream or 1011 feet from a pond or lake?❑ Yes BNo❑ Don't Know <br /> Is there a wetland or floodplain on or near the pri perry? B Yes❑No❑ Don't Know <br /> Is this project associated with a recent rezone/C '/variance?BNo If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes BNB <br /> Have you contacted the Dane County Land and ater Resources Department about this project?❑*es❑No <br /> Most applications must be accompanied b a survey showing the following: <br /> ❑ Property lines with dimensions <br /> ❑ All existing structures Permit Fee due at time of application <br /> ❑ Any proposed structures Please have cash or check payment available <br /> ❑ All impervious surfaces at time of application submittal. Checks are <br /> ❑ All vegetative areas payable to Dane County Zoning. The fee for <br /> ❑ Ordinary High Water Mark a shoreland zoning permit is$150.00 and is <br /> ❑ Topographic data(2-foot contour l non-refundable. <br /> I,the undersigned,hereby make application for a sh.reland zoning permit and certify to the accuracy of the information. I <br /> further certify I am the property owner,or a duly authorized representative,and may sign this permit application on the <br /> behalf of the owner(s)of said pro <br /> Applicant signa Date: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DC' HL Application.docx Version 1.1 Created 12272013 <br />