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Dane County Shoreland Zoning Zoning office use o„4, <br /> Permit Application Moreland Permit#:DCPsHL- 16 - <br /> Application must be made in person Zoning Permit It 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 /> Kurt Dickey,Lois Harr ultimate excavating <br /> Address Agent Address <br /> 2217,2229 William Point w7845 hwy 106 <br /> City,State,Zip City,State,Zip <br /> Stoughton Wi 53589 Fort Atkinson wi 53538 <br /> Phone Agent Phone <br /> 815-978-5876 920-650-1135 <br /> E-Mail Agent E-mail <br /> Mglockz @aol.com mglockz @aol.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 2217,2229 William Point Pleasant springs '%` •42&•758 <br /> Parcel Number(s) Zoning District <br /> 0611-191-3409-6 &0611-191-3562-0 r3 dcprez-0000-00336 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Repair of the two shorelines <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? 8 Yes ❑No❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? No If yes, petition/appeal# <br /> Is this permit to correct a violation? El Yes BNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑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 /> 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 /> Digitally signed by Marc Garlodr <br /> Marc Garlock°N 7_,== 5-12-16 <br /> email=nglockz@ad.wm,c=US <br /> Applicant signature: Dale 2016.05.1122.1844-05'00' Date: <br /> H_1Zoning\Shorcland-Wctland Zoning*Chapter 11 FormADCPSHL=Applicationtloot Vst lOf 1:1 of M54 I3I OI <br />