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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 /> ,-Q Shoreland Water body: /,4t, Identification N--., DNR designated? ❑Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> Kxisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): Sq Ft <br /> Total Lot: 10 ,- 4~]0 <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious O a7 0 1 p 5 <br /> Percent impervious ) Q 4) / 0 ri 0 <br /> Project meets shoreland standards:( Yes ❑No Shoreland zoning permit denied: ❑Yes <br /> git <br /> o <br /> Additional Dane County permits needed: <br /> KShoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ,\Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: 7Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shorelan a •o ing permit on ho`for other permits <br /> Issued b/ __Aft % Date IMP <br /> Assis ant onmg Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />