Laserfiche WebLink
Dane County Shoreland Zoning zoning office use onlv <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 /> N.. Agent Name <br /> 0}11 O DE 'Z 1C - <br /> Address Agent Address <br /> ZSOt'P B-Q- 0 t <br /> City State,Zip City,State,Zip <br /> .hlA-tD1 J t � 5 r71 I <br /> Agent Phone <br /> (-00i . S S 9 39 <br /> E-Mail Agent E-mail <br /> -7J (./ i/ <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address �/�� Town/Section Acreage <br /> f 7/ ( <br /> Parcel Number(s) Zoning District <br /> CSM Lot Subdivision Block/Lot <br /> S I <br /> Project Description <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? [Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes ❑No V.Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? [No If yes, petition/appeal# . <br /> Is this permit to correct a violation? [ Yes ❑No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? Ut.Yes ❑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 /> 6, ..„.. <br /> Applicant si nature.i �� '' Date: /1 t l <br /> P 9 <br /> H:\Zonine\Shoreland-Wetland Zoning\Chanter 11 Fonns\DCPSHL Application.docx Version 1.1 Created 12272013 <br />