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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> fA(1000' of a lake or pond 300' of lake, pond, river or stream 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: t -Z Identification: C-J ., \DNR designated? es ❑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 /> ;(Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: .S l��� <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot JS & o-, <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious ( -1 3 S <br /> Percent impervious `� , 1% % a, C) / g �C/o <br /> Project meets shoreland standards:,es ❑No Shoreland zoning permit denied: ❑Yes No <br /> Additional Dane County permits needed: <br /> jSZ Shoreland Erosion Control Permit Shoreland Mitigation Permit ante <br /> ❑Floodplain development permit Zoning Permit <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> 'Sho':1. - • zo i' . permit o hold for other permits <br /> Issued by '!__.' „ ,' Date h/ 1'(ViC <br /> • sistant otnng • • nistrat:r <br /> H:Zoning',Shoreland-Wetland Zoning',Chapter 11 Fonns\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />