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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 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 /> Shoreland Water body: 1-4t.ER-15cvioe Identification: Li:J- . DNR designated9,11Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> $� Floodplain FEMA map panel: 55025C Flood zone: A. 1fEz <br /> ❑Floodway Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): pl C Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot °I S <br /> Primary building <br /> footprint <br /> Accessory building(s) C r <br /> Driveway <br /> Any other impervious <br /> Total impervious U n 4 7 3%4C <br /> Percent impervious 1.13-.3 4 O.a- <br /> Project meets shoreland standards:'Yes ❑No Shoreland zoning permit denied: ❑Yes fC2I,No <br /> Additional Dane County permits needed: <br /> ,R'Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> f23 Shoreland g permit on ld for other permits <br /> /, /jz <br /> Issued by���%�-----� Date HM <br /> S <br /> Assistant Zoning Administrator / <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Fonns\DCPSHL_Application.docx Version 1.0 Created 04012013 <br />