Laserfiche WebLink
Dane County Shoreland Zoning Zoning office use only <br /> Permit Application shoreland Permit#: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 /> ,Vc„f.,i� ,02.4)�71/, ,/,4/-e6:.5" 4 Rey-chi/044) <br /> Address • - Agent Address <br /> ;'70/ -S' /P' !rO 7 9 9 C ,vrl,g.f4- 4 V <br /> City,State,Zip City,State,Zip <br /> Co,er-6 God✓, Al( 0 .�e7el 4J/ -3.3/ <br /> i <br /> Phone Agent Phone <br /> i - .3_cI— / ¢iZ-. Gds' - 413 9- /3 11 'o <br /> E-Mail Agent E-mail <br /> 7O,Jd,),ovAl.Ee 49 V4,t'co, ca,4 .,/, rH,0i/,J&, (/ , '24J , cam <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Section Ir �% �E% % aS. Acreage ^ <br /> _' '70/ ✓� /`7D,E /2� v 1-4- /Y G/./� (7� <br /> i <br /> Parcel Number(s) 6/5/02/1 ,y01, 7cx_ii Zoning District A ,CSM ot Subdivision Block/Lot <br /> p.r ..---- - ,_ <br /> Project Description <br /> .�a'i( 46- 1 # ' -/ ,Qil2^-) . <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? IF] Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? Fg Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? CXINo If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes WiNo <br /> Have you contacted the Dane.County Land and Water Resources Department about this project? El Yes No <br /> Most applications must be accompanied by a survey showing the following: <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 /> the undersigned, hereby make application for a shoreland zoning permit and certifyto 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 /> y/ <br /> , : 7 � <br /> Applicant signature: Date: 7.4° --1-- A3 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chanter 11 Forms\DCPSHL Anolication.docx Version 1.1 Created 12272013 <br />