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Dane County Shoreland Zoning Zoning office USE only <br /> Permit Application Shore land Penult#: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 /> Name Agent Name <br /> Andy and Claire Pharo Kevin Even <br /> Address 6954 Rembrandt Rd Agent Address <br /> 5174 Reynolds Ave <br /> City,State,Zip Waunakee, VIA 53597 City,State,Zip <br /> Waunakee, wi 53597 <br /> Phone 608-849-5950 608-849-1 077 Agent Phone 608-345-1094 <br /> E-Mail Apharo@pharoheating.t:om Agent E-mail <br /> kevineven @yahoo.com <br /> Property Location Information (http:! accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 36 T9N R9E / se /y, sw 1 .31 <br /> Parcel Number(s) Zoning District <br /> 064/0909-363-9730-0 R-1 <br /> CSM Lot Subdivision Block/Lot <br /> Lantern Hollow 3 <br /> Project Description <br /> Removal of existing shed and building new single family home <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 O Don't Know <br /> Is there a wetland or floodplain on or near the property? ® Yes ❑■o ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? UNo If yes, petition/appeal# <br /> Is this permit to correct a violation?❑ Yes BNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project?0 aloes ONo <br /> Most applications must be accompanied by a survey showing the following: <br /> iz Property lines with dimensions <br /> O All existing structures Permit Fee due at time of application <br /> §t Any proposed structures Please have cash or check payment available <br /> X All impervious surfaces at time of application submittal. Checks are <br /> ¢ All vegetative areas payable to Dane County Zoning. The fee for <br /> u Ordinary High Water Mark a shoreland zoning permit is$150.00 and is <br /> m1: Topographic data(2-foot contours) non-refundable. <br /> I,the undersigned,hereby make application for a 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 property. /� c <br /> Applicant signature: likas-t ► `'O V 1 Date: 10 Z3 ( <br /> H\ioning\Shoreland•Wetland Zoning\Chapter I I Forms\tX'PSI IL_Apphcation docx Version 1 1 Created 12272013 <br />