Laserfiche WebLink
Dane County Shoreland Zoning ning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- - <br /> Application must be made in person Zoning Permit#DCPZP- - <br /> Shoreland Zoning Permit fee is$150 <br /> A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County <br /> Zoning Division for any development within the shoreland district. <br /> Property Owner Information Agent Information <br /> Name Agent Name <br /> Jeff and Nancy Ballmer Robert Feller <br /> Address Agent Address <br /> 9661 Howery Rd 6917 Ramsey Rd <br /> City,State,zip Mt Horeb, WI 53572 City,state'zip Middleton, WI 53562 <br /> Phone Agent Phone <br /> 608-437-4636 608-444-6988 <br /> E-Mail Agent E-mail <br /> jtballmer @gmail.com bob.feller @iconicacreates.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 9661 Howery Rd Vermont Township/24 Y. NE ,1/4 4 14 NW 21 .66 <br /> Parcel Number(s) Zoning District <br /> 0706-242-8001-5 A-2 <br /> CSM Lot Subdivision Block/Lot <br /> 5857 - - - <br /> Project Description <br /> Expansion to an existing single family residence. <br /> Please answer the following questions to the best of your ability: <br /> Is the property within 300 feet of a stream or 1000 feet from a pond or lake? 8 Yes ❑No El Don't Know <br /> Is there a wetland or floodplain on or near the property? 8 Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? ONO If yes, petition/appeal#3676 <br /> Is this permit to correct a violation? ❑ Yes B No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? El Niles ❑No <br /> Most applications must be accompanied by a survey showing the following: <br /> ❑ Property lines with dimensions <br /> ❑ All existing structures Permit Fee due at time of application <br /> ❑ Any proposed structures Please have cash or check payment available <br /> ❑ All impervious surfaces at time of application submittal. Checks are <br /> ❑ All vegetative areas payable to Dane County Zoning. The fee for <br /> ❑ Ordinary High Water Mark a shoreland zoning permit is $150.00 and is <br /> ❑ Topographic data(2-foot contours) non-refundable. <br /> I,the undersigned, hereby make application for a shoreland zoning permit and certify to the accuracy of the information. I <br /> further certify I am the property owner,or a duly authorized representative,and may sign this permit application on the <br /> behalf of the owner(s)of said property. <br /> Applicant signature: { Date: 07-12-2016 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />