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i <br /> ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> o a e00' of lake, pond, river or stream >c 300' of a floodplain <br /> AA floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: rnew►7 UttitDA Identification: ?. St'r4 DNR designated? 1Yes ❑No <br /> c_Ilew fi <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> PFloodplain FEMA map panel: 55025CSSo Flood zone: sit-z5 = E <br /> ❑Floodway ❑Flood fringe Weneral floodplain ❑Flood storage' <br /> Lot <br /> - .. xisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> )( 4.4>< <br /> Driveway <br /> Any other impervious <br /> Total impervious <br /> Percent impervious <br /> Project meets shoreland standards: CI Yes ❑No Shoreland zoning permit denied: Ill Yes ❑No <br /> Additional Dane Countrf ermits needed: <br /> ❑ Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ❑ Zoning Permit ❑ <br /> Additional information required: 1 <br /> _r ? � �- ii‘-) <br /> STATUS: ❑ Shoreland zo i'n_ permit and/or zoning permit issued contingent upon other permits <br /> Sh• = . ■ z•.4 .ermit o 1 old for other permits <br /> Issued by �I Amillirdp Date 1 JL <br /> Assistant onmg Atmmistra <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />