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Dane County Shoreland Zoning Zoning office use only Permit Application shoreland Permit#:DCPSHL- n - ! Application must be made in person Zoning Permit#DCPZP- - Shoreland Zoning Permit fee is$150 A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County Zoning Division for any development within the shoreland district. Property Owner Information Agent Information Name Agent Name Joel Brown Address 2834 Lakewood Circle Agent Address City,State,Zip Stoughton WI, 53589 City,State,Zip Phone Agent Phone 414-507-3908 E-Mail, Agent E-mail joel.r.brown @gmail.com Property/Location Information (http://accessdane.co.dane.wi.us) Property Address Town/Section Acreage 2834 Lakewood Circle T6N/Section 7 Range 11 E ' `'/ 1 .7 Parcel Number(s)046/0611-072-9980-6 Zoning District Al EX CSM Lot Subdivision Block/Lot Project Description Construct a 30x40 garage on the property in the location identified on the accompanied plat of survey. The building will also have an approximate 1000sq ft asphalt driveway as well. Please answer the following questions to the best of your ability: Is the property within 300 feet of a stream or 1000 feet from a pond or lake? 8 Yes No ❑ Don't Know Is there a wetland or floodplain on or near the property? ❑ Yes BNo ❑ Don't Know Is this project associated with a recent rezone/CUP/variance? IRNo If yes, petition/appeal# Is this permit to correct a violation? ❑ Yes •No Have you contacted the Dane County Land and Water Resources Department about this project? ❑Wes ENo Most applications must be accompanied by a survey showing the following: ❑ Property lines with dimensions ❑ All existing structures Permit Fee due at time of application ❑ Any proposed structures Please have cash or check payment available ❑ All impervious surfaces at time of application submittal. Checks are ❑ All vegetative areas payable to Dane County Zoning. The fee for ❑ Ordinary High Water Mark a shoreland zoning permit is $150.00 and is ❑ Topographic data(2-foot contours) non-refundable. I,the undersigned, hereby make application for a shoreland zoning permit and certify to the accuracy of the information. I further certify I am the property owner, or a duly authorized representative, and may sign this permit application on the behalf of the owner(s)of said property. Joel Brown DDatgeta:l2ly 0 17gn0e4d 2 b7 y 1 J4o5e9l Brown 5 '00' Applicant signature: Date: H:\Zoning\shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013