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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 /> Shoreland Water body: pov\ Identification: _ DNR designated? Yes No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway EFlood fringe III General floodplain ❑Flood storage <br /> Lot <br /> Xxisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): i o Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot j q,3t-i O <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> 0 )- 1' 0 0 <br /> Driveway <br /> Any other impervious <br /> Total impervious )- F--0 GT) / -O 0 <br /> Percent impervious 6. �% <br /> Project meets shoreland standards: Yes EINo Shoreland zoning permit denied:) lY� <br /> Additional Dane County permits needed: <br /> x Shoreland Erosion Control Permit El Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit -Gal Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> JEL S i o d . '' _permit on hold for other permits <br /> Issued by i___ fillr Date CA/0— <br /> s stant onmg •.mimstrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />