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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 00' of lake, pond, river or stream ❑ 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland Cl The vegetative buffer zone <br /> "Shoreland Water body: LoY.42, K 0r\ Identification: DNR designated- es ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres \\ <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway El Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> LA-Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: ii aOO <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Pro osed Post Development <br /> Lot / S/14 . - <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious 1--1 a.S G 13 5 Lt 301 ) <br /> Percent impervious , I ' CZ•,q% <br /> Project meets shoreland standards es ❑Nol', Shoreland zoning permit denied: ❑YesJ:S'I4o <br /> Additional Dane Coun i ermits needed: , <br /> Shoreland Erosion Control Permit .i." 1 horeland Mitigatiou-9ermit ❑Variance <br /> ❑Floodplain development permit ❑ Zoning,Permit ❑ <br /> Additional information required: <br /> STATUS: ]a Shoreland zoning permit and/pr zoning permit issued contingent upon other permits <br /> CI S •i an• -o'ing permit o I Fold for other permits n <br /> s, <br /> Issued b . Ap Date <br /> si"Art oning .ministrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />