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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 ly:(300' of lake,pond, river or stream I11300' of a floodplain <br /> El A floodplain ❑ 75' of a wetland El A wetland El The vegetative buffer zone <br /> Shoreland Water bod : Identification: Ur*,h DNR desi ated? Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe El General floodplain ❑Flood storage <br /> Lot <br /> R Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): <br /> Total Lot: t4,1 i 560 3 Sq Ft <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot +1- 3' 3 0 o <br /> Primary building <br /> footprint <br /> 4, Z <br /> Accessory building(s) <br /> b <br /> Driveway Q,8 4 <br /> Any other impervious C5 <br /> Total impervious 5 , 3 0 £4. <br /> Percent impervious ( 3 , S 0/q <br /> Project meets shoreland standardscYes ❑No Shoreland zoning permit denied: ❑Yes o <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit El <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 G <br /> •ssis .."i.T�iig ••mmistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.0 Created 04012013 <br />