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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application ShorelaudPeivrit#:DCPSHL- - <br /> s <br /> Application must be made in person Zoning Pemrit r 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. ��5� �2►'' k,)ts <br /> Property Owner Information Agent Information <br /> Name ,0 Agent Name / <br /> �Pq/? r T L° 1 raf e /t°S t7'i;1Mm�i- 17L Consirc oy-7Ylh. <br /> AOres Agent Address <br /> r I1{V 237.3 x,17 <7 /9-6 <br /> City,C /l a/10( Cy 53 s--5-? City, Fq / Gt// 5-35-75-r <br /> Phone Agent Phone <br /> r 77,—C // <br /> E-Mail / M Agent E-mail 1 1 <br /> Spem 5(OP1PQ/I y o Ca/r► hQmfIer //-CnS�rrr /G,1 G cjf''t qi1/c/i-■ <br /> Property Lora: on Information ihttp accessdane co dare wi_us ) <br /> Property Address Town/Section :" <br /> 222a Ccn¢y /fi i i9 �DC�i1�-, 23 2,y <br /> Parcel Number(s) Zoning District <br /> 02g"/0610 —232- 10/2-1 <br /> CSM Lot Subdivision Block/Lot <br /> I CoLL6Wa pc , -, l / <br /> Project Dess r!pt cn <br /> silo/ Front- Orel R e�fc c S:de 4/e5 a-,rye s, P97 , Oecx- <br /> P:47111,04tse. keotoqz/ <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❑No❑ 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?DirNo If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes KNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project?❑ 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 pro rty <br /> 1-3 -,/6 <br /> Applicant signature: Date: <br />