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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- / - <br /> - <br /> Application must be made in person Zoning Permit#DCPZP- <br /> Shoreland Zoning Permit fee is$150 <br /> A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County <br /> Zoning Division for any development within the shoreland district. <br /> Property Owner Information Agent Information <br /> NameRiesop Farms LLC Agent Name David Riesop <br /> Address Agent West Quarry St Agent Address 306 West Quarry St <br /> City,State,Zip City,Wi 53531 City,State,ZiPDeerfield, Wi. 53531 <br /> Phone Agent Phone <br /> 608-764-5602 <br /> E-Mail Agent E-mail <br /> wismapping @charter.net <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 4757 Ridge Road,Deerfield Sun Prairie 36 1/4 SW 1/41/. NW 440 <br /> Parcel Number(s) Zoning District <br /> 0811-363-8500-2, 0811-362-90006 A-1 ex <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> borrow and fill for building site for ag building <br /> Please answer the following questions to the best of your ability: <br /> Is the property within 300 feet of a stream or 1000 feet from a pond or lake? II Yes ❑No Cl Don't Know <br /> Is there a wetland or floodplain on or near the property? 8 Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? IR No If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes NNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? Yes❑No <br /> Most applications must be accompanied by a survey showing the following: <br /> ❑ Property lines with dimensions <br /> ❑ All existing structures Permit Fee due at time of application <br /> ❑ Any proposed structures Please have cash or check payment available <br /> at time of application submittal. Checks are <br /> ❑ All impervious surfaces <br /> All vegetative areas payable to Dane County Zoning. The fee for <br /> ❑ Ordinary High Water Mark a shoreland zoning permit is $150.00 and is <br /> ❑ Topographic data(2-foot contours) non-refundable. <br /> I,the undersigned, hereby make application for a shoreland zoning permit and certify to the accuracy of the information. I <br /> further certify I am the property owner,or a duly authorized representative, and may sign this permit application on the <br /> behalf of the owner(s)of said property. <br /> Applicant signature:-- ! Date: -3/ .7/ ..)/7 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />