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a � <br /> ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> 000' of a lake or pond 1140' of lake, pond, river or stream R 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland fhe vegetative buffer zone <br /> ,Shoreland Water body:1,-q k-€ Identification:-Jtk DNR designated?'Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland <2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe El General floodplain ❑Flood storage <br /> Lot n <br /> xisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): <br /> Total Lot: Sq Ft <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 /> Driveway <br /> Any other impervious <br /> Total impervious La S <br /> Percent impervious S7 q _ 9 <br /> Project meets shoreland standards:J)-1-Yes ❑No Shoreland zoning permit denied: ❑Yes 9No <br /> Additional Dane County permits needed: 11 <br /> AShoreland Erosion Control Permit Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit )5\ p <br /> �/ S t/4 7 /0/1 0/1 <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Shoreland 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 />