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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> ❑ 1000' of a lake or pond ..N 300' of lake, pond, river or stream ❑ 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> 50horeland Water body: /L Identification: R13 Q c^^^ DNR designated? Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> t;Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: ))3n <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot fl 31 -1 <br /> Primary building <br /> footprint <br /> Accessory building(s) -� i G <br /> Driveway <br /> Any other impervious <br /> Total impervious Cs 5 C�, I <br /> Percent impervious (/C) <br /> Project meets shoreland standards,---. ❑No Shoreland zoning permit denied: ❑Ye o <br /> Additional Dane County permits needed: <br /> ❑ Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit ❑ <br /> Additional information required: WO /(/.) irb�'jd'L_ <br /> STATUS: Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shorel. zonin_ :-rmit on hold for other permits <br /> ' J / <br /> Issued by ,r∎�✓, Date/0 i`• ■ <br /> • sis .nt o •'• •ammistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />