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.r.r <br /> ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> .g‘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 /> . f4 Shoreland Water body:1-0,k-Q_ f yj a entification: DNR designated?c\Yes ❑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 ,D '_ zS\ <br /> Lot <br /> XExisting ❑ Existing non-conforming ❑New . <br /> Impervious Surface Calculations <br /> Area (square feet): I.-- S S OI Sq Ft <br /> Total Lot: • <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 13 % °\ <br /> Primary building <br /> footprint <br /> Accessory building(s) • <br /> Driveway <br /> Any other impervious <br /> Total impervious @0 9 G-a ca <br /> Percent impervious <br /> Project meets shoreland standards: es ❑No Shoreland zoning permit denied: ❑Yes; No <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ❑ Zoning Permit -4?!1— <br /> Additional •' formation required: IA., A !' b i�—S ✓•- c-'� L x'S�r` • <br /> 'ter s -rQe c f oPe(ky S <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon`other permits <br /> -hor- an. honing .e It on hold for other permits l <br /> Issued by <br /> i Date. . rT 0 <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.di CX 'Version 1.1.Created 12272013 <br />