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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> 1000' of a lake or pond :4 300' of lake, pond, river or stream 300' of a floodplain <br /> 1XcA floodplain ►: 75' of a wetland A wetland The vegetative buffer zone <br /> A Shoreland Water body)C3ko,/'aN Identification:g 1,u l' DNR designated?•cfYes ❑No <br /> ❑ Wetland Shoreland wetland El Inland wetland III Wetland<2 acres <br /> Floodplain FEMA map panel: 55025C q 6O-7-U Flood zone: Af- <br /> 7Cifloodway NFlood fringe ❑General floodplain Flood storage <br /> Lot <br /> - . Existing ❑ Existing non-conforming ❑New <br /> I <br /> Impervious Surface Calculations <br /> Area (square feet): <br /> Total Lot: l ill S Q Sq Ft <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot i l N SO-4 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious <br /> Percent impervious <br /> Project meets shoreland standards: ISIYes ❑No Shoreland zoning permit denied: ❑Yes3No <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: £d�1,4. 41--/-7 , c.ess->~ i k t,✓.� 0,111r)01 <br /> �..j oy.. no of-..VLidi Cllr <br /> fjQ <br /> STATUS: ]'Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ or- an. it g permit on hold for other permits <br /> Issued by 4-4oflffigAdmjfltor . Date 0 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />