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_y7 <br /> Dane County Shoreland Zoning Zoning use only <br /> Permit Application Shoreland Permit#:DCPSHL- /C - S <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 /> Andrew and Farrah Slinger <br /> Address Agent Address <br /> P.O.Box 290 4604 Siggelkow Road,Suite A <br /> City,State,Zip City,State,Zip <br /> Arlington,WI 53911 McFarland,WI 53558 <br /> Phone Agent Phone <br /> (808)225-3331 (808)838-77550 <br /> E-Mail Agent E-mail <br /> slingera©sba.com <br /> Property Location Information (http: accessdane.co.dane.wi.us) <br /> Property Address N/A Town or /38 y, SE y,% SW Acreage 1.54 <br /> Plural Number(s) PIN: 0909-363-9770-0 Zoning District <br /> R-1 DCPREZ-0000-09993 <br /> CSM Lot Subdivision Block/Lot <br /> N/A N/A Lantern Hollow 7 <br /> Project Description <br /> The project consists of constructing a new house and 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? 8 Yes❑No ❑Don't Know <br /> Is this project associated with a recent rezone/CUP/variance?BNo If yes, petition/appeal# <br /> Is this permit to correct a violation?❑Yes No <br /> Have you contacted the Dane County Land and Water Resources Department about this project?❑*es OM <br /> Most applications must be accompanied by a survey showing the following: <br /> o Property lines with dimensions <br /> a All existing structures Permit Fee due at time of application <br /> a Any proposed structures Please have cash or check payment available <br /> a All impervious surfaces at time of application submittal. Checks are <br /> o All vegetative areas payable to Dane County Zoning. The fee for <br /> a Ordinary High Water Mark a shoreland zoning permit is$150.00 and is <br /> v 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. <br /> Applicant signature: Date: . S12/)/6 <br /> l <br /> H:1Zoning\Shorel and-Wetland Zoning\Chapter 11 Forms'DCPSHL Application.docx Version 1.1 Created 12272013 <br />