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ZONING OFFICE USE ONLY ZOMNG OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> D 1000' of a lake or pond 521 300' of lake,pond, river or stream ❑ 300' of a floodplain <br /> ❑ A floodplain LI 75' of a wetland E A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: Y e "-sr-. Identification -r , D?NTR designated Yes J\To <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> EFloodway EFlood fringe 0 General floodplain EFlood storage <br /> Lot <br /> 7i Existing ❑ Existing non-conforming =New <br /> 1 i. <br /> 1 Impervious Surface Calculations <br /> 11 Area (square feet): I S <br /> i Total Lot: A3/ �U q Ft <br /> I Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot <br /> 1 Primary building <br /> footprint ( q t ' to 4 1 <br /> Accessory building(s) <br /> Driveway I 6 59 I(05`/ <br /> Any other impervious 105 i 65 <br /> Total impervious i &( 75 `3\-") O c' s 9 OeSO q P7I. <br /> Percent imp <ervious I 6 , 17 �`, '/ J 6„6 /icy� <br /> I <br /> jProject meets shoreland standards: : Yes -`No Shoreland zoning permit denied: EYes o <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit 7: Shoreland Mitigation Permit ❑Variance <br /> 1 <br /> `Floodplain development permit Zoning Permit 0 <br /> 1 <br /> Additional information required: Am _ a 411 i ✓LA <br /> r <br /> i <br /> a STATUS: JPK8horeland zoning permit and/or zoning permit issued contingent upon other permits <br /> 1 <br /> a ❑ Sho - > .d z .'• permit on .r old for other permits <br /> Y <br /> Issued by Z�- �:._„gado Date <br /> Assistant onmgA•mmistrato - <br /> H.\ZoninglShorcland-Wctland Zoning\Chapter 11 Fonns`,DCPSHL Application.docx Version I.1 Created 12272013 <br />