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• <br /> ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> N/1000' of a lake or pond 300' of lake,pond, river or stream 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland O A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: LEVI e, Identification: �-°� 2 DNR designated?9Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ F000dplain FEMA map panel: 55025C 01-1- 17/-4 Flood zone: AE <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage Q <br /> Lot <br /> Existing ❑ Existing non-conforming ❑New <br /> CS iv VI/a <br /> Impervious urface Calculations <br /> Area(square feet): Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot -?J-L-k I:95 <br /> Primary building <br /> footprint <br /> Accessory building(s) 3 o <br /> Driveway <S Q <br /> Any other impervious <br /> Total impervious Q <br /> Percent impervious <br /> Project meets shoreland standards:]Yes ❑No Shoreland zoning permit denied: ❑Yes,41-No <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit , Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: O Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> —� Shor- and o i• g permi ion hold for other permits <br /> Issued by _�/,_ _ _�� Date �0 S <br /> As is .,t oning A. unstrati" AS <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Fonns\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />