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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Project includes development within: (check all that apply) <br /> 1 1000' of a lake or pond ..,R'300' of lake, pond, river or stream Iii, 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> WA..4sc, <br /> Shoreland Water body: Lam Identification: !1.-,:. DNRdesignated`-Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland <2 acres <br /> 13, Floodplain FEMA map panel: 55025C Flood zone: ��4. Q,�E^ ayc . <br /> ❑Floodway1Flood fringe ❑General floodplain ❑Flood storage <br /> Lot II <br /> _ZiExisting ❑ Existing non-confotniing ❑New <br /> Impervious Surface Calculations <br /> Area(square feet): <br /> I Total Lot: c) Sq Ft <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot <c 9 3- 'c\.'3-0 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious . 1 `7 I S -J-1 0 C0 0 3–7 LS Percent impervious =30,'-170 Li j . G% <br /> __- <br /> Project meets shoreland standards: ❑Yes 0- '\--- <br /> No � Shoreland zoning permit denied: 0 YestiNo <br /> Additional Dane County permits needed: <br /> 7 Shoreland Erosion Control Permit IV Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ,Ki Zoning Permit ❑ <br /> Additional information required: p.., ,r, L S c 1 J �a CIr cz--- il l'6. Q <br /> 3 \3 <br /> STATUS: ❑ Shoreland zoning peuvit and/or zoning permit issued contingent upon other permits ,� <br /> Shorelandi ring pelulit iin hold for other permits <br /> Issued by /7 ,— ---- � Date �-7, <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHI, Application.docx Version 1.1 Created 12272013 <br />