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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 c00' of lake, pond, river or stream 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> 3LShoreland Water body: Lemke Identification: fr1t' DNR designated7TYes ❑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 /> Cxisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: 143 "-1") <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot $CGw °I <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious <br /> 00 0 <br /> Percent impervious 1Z _ ejc - �� <br /> Project meets shoreland standards: acres ❑No Shoreland zoning permit denied: ❑Yes.No <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: (JQeas C T re tj;tv./\;-No f/G� <br /> ) V <br /> -Coe Co e -Po()"-%- L- S r /0/AieN <br /> STATUS: _1Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ re .nd ing permit on ho d for other permits <br /> i <br /> Issued by ' Date IQ 4) <br /> sistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter I 1 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />