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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> 1000' of a lake or pond Al 300' of lake, pond, river or stream Al 300' of a floodplain <br /> \A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> ❑ Shoreland Water body: 1-0.1-1. 41_Identification: L 4 DNR designated lYes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland El Wetland <2 acres <br /> ti .Floodplain FEMA map panel: 55025C 044114 1-I Flood zone: A E <br /> ❑Floodway ' Flood fringe ❑General floodplain Flood storage <br /> Lot 2p , B' Q19/0 : LI5e-S, S <br /> Gl' xisting ❑ Existing non-conforming ❑New C s ` ,r / G <br /> `7 t) 94 O U2() <br /> Impervious Surface Calculations <br /> Area (square feet): <br /> Total Lot: )S OS S Sq Ft <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 1 Sgcs S <br /> Primary building <br /> footprint '/'s €0045 tt <br /> Accessory building(s) <br /> Driveway 6 S <br /> Any other impervious 'I <br /> Total impervious t- S( o Sc1 4Q <br /> Percent impervious % %I <br /> Project meets shoreland standards: ❑Yes)No Shoreland zoning permit denied: ❑Yes ) No <br /> Additional Dane County permits needed: <br /> Fev.AeS /fl I <br /> Z'kShoreland Erosion Control Permit J Sho Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ji4I Zoning Permit ❑ <br /> Additional information require' . r� ti; ►�a� <<�.����y�=���„ <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Shor-land z• ing permit on hold for other permits <br /> Issued by 4.. / Date SS <br /> ssistant Zoning Administrator <br /> H.\Zoning\Shoreland-Wetland Zoning\Chapter II Forms\DCPSHL_Application.docx Version 1.I Created 12272013 <br />