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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 ,300' of lake, pond, river or stream .'300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: Gc-'1;)0_/--- <br /> Identification: CPek DNR designated2 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 /> fAExisting III Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): � ����F Sq Ft <br /> Total Lot: `:�' <br /> Within 300' of . <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 'n1 F•n - -. <br /> Primary building <br /> footprint I Li 1-1 <br /> Accessory building(s) <br /> )1C-a__ 1 L-I-1,1 O <br /> Driveway 3/-/ q S <br /> Any other impervious <br /> Total impervious -6 3 o(1 -Z i,4 9 <br /> Percent impervious 3 C'A S I . a �to <br /> Project meets shoreland standards- Yes ❑No Shoreland zoning permit denied: ❑Yes to <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit XZoning Permit ❑ <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Ar S o el.. d zo .. g permit on hold for other permits <br /> Issued by ��' Date 3/3)-714— <br /> •ssi""r :nmg •Immistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />