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-/ E- /- <br /> Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- G - <br /> Application must be made in person Zoning Permit#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 /> Dane County Sarah Close <br /> Address 5201 Fen Oak Dr Agent Address 5201 Fen Oak Dr <br /> City,State,Zip City,State,Zip <br /> Madison, WI 53718 Madison, WI 53718 <br /> Phone Agent Phone <br /> 608-224-3730 608-224-3743 <br /> E-Mail Agent E-mail <br /> close.sarah @countyofdane.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section NW NW Acreage <br /> N/A TO5NRO8E 03 y, i/°1/° 74.9 <br /> Parcel Number(s) Zoning District <br /> 0508-032-8505-0 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Replacing an existing concrete flat-span bridge that had become unsafe. Installing new clear-span arched bridge for pedestrian traffic. <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? B Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? M 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? ❑ Yes •No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑Wes EINo <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 /> payable to Dane County Zoning. The fee for <br /> ❑ All vegetative areas <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. <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 /> /1 Digdally signed by Sarah Close <br /> Sarah Close o C e DN cn=Sarah Close,o=Dane County Parks,ou 6/9/16 <br /> Sarah v J�J ema 1=Uose.sarah @countyofdane com,c=US <br /> Applicant signature: Date:201606.09 11:44:91-05'00' Date: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />