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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application . , 4#14 c- oii <br /> Shoreland Permit#:DCSHL- - <br /> Zoning Permit#DCPZP <br /> Application must be made in person <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 /> Name William Glenn Agent Name <br /> ohs; s 0eotncx,nn <br /> Address 517 N. Everitt, Palatine, IL 60074 AgentAddess <br /> 3�BS DER lk]1AT OR �Tou6i4ToA col ..89' <br /> Phone �j/ ;v 37 ^ 0003 Agent Phone <br /> 4.03-877-11'3 <br /> E-Mail bglenn @bmk8.com Agent E-mail <br /> clIc: s e skavbv.iders. com <br /> Property/Location Information (http:l/accessdane.co.dane.wi.us) <br /> Township Dunn Section 09 y4 NW '/1/4 SE Acreage.22 <br /> Parcel Number(s)061 0-092-6001-4 Zoning District R-4 <br /> CSM Lot Subdivision Greenridge Park Block/Lot 1/1 <br /> Project Description <br /> This project consists of demolishing an existing house,removing the existing drive,and constructing a new house with attached garage and concrete driveway. <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? B Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? B Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? No If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes BNo <br /> Have you contacted the Dane County Land and Water Conservation Department about this project? B Yes❑No <br /> Application must be accompanied by a survey showing the following: (minimum requirements) <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 contours) non-refundable. <br /> 1,the undersigned,hereby make application fora shoreland 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 /> t °/5-Applicant signature: f ` . . = <br /> HA7nnino\Rbnroln..A-Wetlun,7nrann\rhn..t*r t 1 rn.....\moor-T A...11:...,,.,.,An..., Cr.....:"..1 n n_e.,.aa AA/WI/111 <br />