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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check 411 that apply) <br /> 1000' of a lake or pond A300' of lake, pond, river or stream __I-0'300' of a floodplain <br /> -17*A floodplain ❑ 75' of a wetland ❑ A wetland El The vegetative buffer zone <br /> 123, Shoreland Water body: J.-...k ! Identification: reAdoek DNR designated?- 'Yes ❑No <br /> ❑ Wetland El Shoreland wetland ❑Inland wetland ❑Wetland< 2 acres <br /> A Floodplain FEMA map panel: 55025C Flood zone: A I <br /> ElFloodway AfFlood fringe ❑Genera floodplain ElFlood storage <br /> Lot <br /> Existing ❑ Existing non-conforming ❑INew <br /> Impervious Surface Calculations <br /> Area (square feet): Gl -S 0 Sq Ft <br /> Total Lot: 1 <br /> Within 300' of <br /> ordinary high water <br /> mark Existing , Additional Proposed Post Development <br /> Lot 0l Er <br /> Primary building <br /> footprint /1 SO -C <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious ! a I n3 C) <br /> Total impervious I 39C,4 <br /> Percent impervious 1•`-i 4 q a, a,�f <br /> Project meets shoreland standards: ❑Yes ❑No Shoreland zoning permit denied: ❑Yes ❑No <br /> Additional Dane County permits needed: <br /> ❑ Shoreland Erosion Control Permit ❑ horeland Mitigation Permit ❑Variance <br /> ElFloodplain development permit ❑ Zoning iermit ❑ . <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shoreland zoning permit on hold for other permits <br /> Issued by Date <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />