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Dane County Shoreland Zoning j Zoning office useoniy i <br /> Permit Application Sho:z.arl3 Perm;-t=:DCPSHI.- - <br /> Application must be made in person Zoning Permit=DCPZP- - <br /> Shoreland Zoning Permit fee is SI SO <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 /> Namx, Agent Name <br /> Address Agent Address <br /> c456 CT VA Z. S ; / <br /> City, Zip G g 51 `k P� c t,,,. <br /> tY p City,State,Zip <br /> et\ 1Ao v 6, uJ I 525512 J o r-VI, E re e_cl o vvv GJ 1 5395/ ' <br /> Phone Agent Phone <br /> Go9 V 3 221`1 a- 7--ZvtS 6K- 577 - I6:5S <br /> E-Mail Agent E-mail N <br /> 1MON� tnGa. 0 kA sc. eh In. 1-5/ �erLE <br /> iekt fiCWc:1-«r1-c <br /> 6 <br /> "Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section %_0.....y% Acreage <br /> 5k6 GrttA 34 -1-6 PRT . N� v <br /> Parcel Number(s) . Zoning District , <br /> 0 be / orb - S 1 8 G 4(6 - R-1 6), 5e t kto... (o 123 <br /> CSM Lot Subdivision Block/Lot <br /> MeA-e--c (f •C 0 .--.4c p,,A <br /> Project Description <br /> C,Ac e e_A -M' (?oicl._ -c C. C,.ctrea4.,.e1 Q c.1c L <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? Yes 0No E 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?pNo If yes, petition/appeal# . <br /> Is this permit to correct a violation? E Yes ZNNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑Yes pNo <br /> Most applications must be accompanied by a survey showing the following: <br /> a Property lines with dimensions <br /> a 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 /> a 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 /> Applicant signature:AJLZ'/A/2 `,CIjL.JkA'1 Date: <br /> /CP <br /> A'7nnino C hnrri anti.Wptlan A 7nn inol'hant.r I 1 Fnrrnc.rit'ACiur Sn..lirat:nn Anry \T..e.n..I I /`r.,... 11111A1': <br />