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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 (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 /> 1 <br /> Shoreland Water body: ;5(0 lA 73,1\z^Identification:k 1 ✓`-(1 DNR designated? Yes No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> -Al Floodplain FEMA map panel: 55025C ) S`7 g Flood zone: j <br /> ❑Floodway ,blood fringe ❑General floodplain ❑Flood storage UJ i 414,0 / <br /> Lot <br /> - Jxisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot (ilfVc Pilo 1 <br /> Primary building )r)-II <br /> footprint <br /> Accessory building(s) <br /> Driveway i 6 'Z f)--e ki <br /> Any other impervious <br /> Total impervious 11 q'7 0( 1 I n -2 0\± <br /> Percent impervious 1 6-, <br /> Project meets shoreland standards:. 1'es ❑No Shoreland zoning permit denied: ❑Yes ENo <br /> Additional Dane County permits needed: <br /> iNI'Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: horeland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shonl. Ad o,• g permit on hold for other permits <br /> Issued by wIP _ —_,.1 Date � °1 7 <br /> sis . onmg As mmistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />