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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> I Project includes development within: (check all that apply) <br /> 1000' of a lake or pond 300' of lake,pond, river or stream 1 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> I Shoreland Water body: kC Identification: Q�iitl,J-p DNR designated? NYes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres//�� <br /> Floodplain FEMA map panel: 550250 Flood zone: AL <br /> ❑Floodway , Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): �^/_ / Sq Ft <br /> Total Lot: 14-7 <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 1-1-7 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious (� S /mac( <br /> Percent impervious i?"-C 7 Q <br /> Project meets shoreland standards: N'Yes ❑No Shoreland zoning permit denied: ❑Yes-NNo <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: 1\14,H/ Go/' c )t r p]r �i Q filA <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> zoning permit on hold for other permits <br /> Issued by Date <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />