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Dane County Shoreland Zoning . <br /> Zoning office„Seonly <br /> Permit Application Shureland Permit DCPSHL- <br /> Application must be made in person Zoning Permit#DCPZP- <br /> Shoreland Zoning Permit fee is$150 . <br /> A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County <br /> Zoning Division for any development within the shoreland district. <br /> Property Owner Information Agent Information <br /> Nagle Agent Name <br /> � - a.( -toklivS Lt-c__ SAi <br /> Address I Agent Address <br /> Sohi .twNt 0 . <br /> Ci4ô ( <br /> e,Ziqq�� City,State,Zip <br /> -dG:tS cm �z 53 7(3 <br /> Phone r 0 40_ 5--D-(0- �3 1 Agent Phone <br /> E-Mail (/�J Agent E-mail <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> CAte AfTCam Why LUi act sbtz <br /> Parcel Number(s) Zoning District <br /> CSM Lot aq Subdiyi o I �a h d r 1 S Block/Lot <br /> Project Description �.t `1 <br /> rk- 1\1,0.0 , • . Iki) <br /> Please answer the following questions to the best of your ability: �/ <br /> Is the property within 300 feet of a stream or 1000 feet from a pond or lake? 1/ Yes ❑No❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? UYYes ❑�No ❑Don't Know <br /> Is this project associated with a recent rezone//CUP/variance? lAIIVo If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes r(A'hlo <br /> Have you contacted the Dane County Land and Water Resources Department about this project?VI/Yes ❑No <br /> Most applications must be accompanied by a survey showing the following: <br /> ❑ Property lines with dimensions <br /> Li <br /> existing structures Permit Fee due at time of application <br /> o 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 /> o Ordinary High Water Mark a shoreland zoning permit is$150.00 and is <br /> ❑ Topographic data(2-foot contours) non-refundable. <br /> I th 0----ii ii ee g ,T412,4-41:4* � i l' la1id„ ontr1 tt and � o cc f the tnfQr atop 1" <br /> r <br /> 0-4:-* �{! � 8�0 6�^���3o d �l� l��������'�s��~������� f��'� � � ��11iQ �� .s�,:�r�_ .,3g �',© P e ® ale 5 ks 7 0 .., x.� .av�` s:.. r <br /> -'uc h � ^Y x-q ,00 s"`' 51.7 �.� s'A _ `� y di a$1,4 � �S} "f y. fir` <br /> .M^+'G.. ?i- �a 'jc l"F.3' r,rr h'\ `vim S 1 1 `� <br /> 4 i A. <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.I Created 12272013 <br />