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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 /> r <br /> c' Shoreland Water body: ll" •,,.....,e_1 Identification: L S A'1ewe.DNR designated?.1Yes ❑No <br /> El Wetland El Shoreland wetland ❑Inland wetland ❑Wetland <2 acres <br /> El Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain EFlood storage <br /> Lot <br /> Existing ❑ Existing non-conforming ENew <br /> Impervious Surface Calculations <br /> Area(square feet): Sq Ft <br /> Total Lot: ) s� <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot F of I 51 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious vt u s,to <br /> Percent impervious fi s <br /> Project meets shoreland standardses ❑No Shoreland zoning permit denied: ❑Yes Eio <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: Dr d.�a ,.,. . 'Lc 63-1-s O( 75 SQ4)04 <br /> re vsA-- P 10-e sip.-. 9. <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Shoreland oning permit on hold for other permits <br /> ��Issued by _-- Date <br /> sistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />