Laserfiche WebLink
Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- - <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 7 Agent Name <br /> rG.c C a ()a rd <br /> Address I ,�,�: II C C� PB Agent Address <br /> I fy ?� <br /> City,State,Zip City,State,Zip <br /> Vgrvny, w S 3 S°l3 <br /> Phone Agent Phone <br /> 34--/S - 9 <br /> E-Mail 1) Agent E-mail <br /> rcic1, Gct,' 1~c ' L-�l�ur�.CC��► <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 1 6`!1 Cry ✓cronet O. 6-1. <br /> Parcel Number(s) Zoning District <br /> Q612.-/060V— 353 - 61%67._ C R-1 b P(?ez-000o-o%c07 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> (3u:11 S - y'x IS <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? f .Yes No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? I Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? SNo If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes tINo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? Z1 Yes ❑No <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 /> ❑ 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 /> ❑ 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:JYraiie 11). Date: /0 AA? ,20�(► <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />