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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> Cikl 1000' of a lake or pond 300' of lake, pond, river or stream dy 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: Identification: DNR designated? ❑Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): S Sq Ft <br /> Total Lot: 3 <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot s--3c--)9 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious ��} �- t4 0 V9\ <br /> Percent impervious 6'°A) el <br /> Project meets shoreland standards° 'es ❑No Shoreland zoning permit denied: ❑Yes rb <br /> Additional Dane County permits needed: <br /> ❑ Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: fi.Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shoreland : •• - it on hold for other permits <br /> Issued b 4"11.116 � Date /‘-7//- <br /> • sistant 'ping •'mmistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />