Laserfiche WebLink
Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- - <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 /> Name Agent Name <br /> 7'4/ t AM-Ale rre 7 Se7J <br /> Address Agent Address <br /> 11?t �n� � tS .6E F/2D 4 6DnAk-94A14 /_,0 <br /> City,State,Zip City,Stat ,Zip <br /> ip <br /> I 35q/ ) - 53S,y <br /> Phone Agent Phone <br /> ,t78 gl(P3'—/Poc (�Og IH 01i/9 <br /> E-Mail Agent E-mail <br /> AMA/ yP$070 _P ie, (..day OGo 7 9 Po 1 1 I-Seel r 04 . eo,q <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address yy Q Town/Section ,,/� Acreage <br /> Parcel Number(s) Zoning District <br /> o e o9 3 3 2, 7/f8 14 e T"Z. <br /> CSM Lot Subdivision Block/Lot <br /> !/ Am. <br /> Project Description <br /> /add ,_ g ,c <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?` —Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yeso ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance?.No If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? es ❑No <br /> Most applications must be accompanied by a survey showing the following: 11 <br /> ❑ Property lines with dimensions <br /> ❑ All existing structures Permit Fee due at time of application <br /> o Any proposed structures Please have cash or check payment available <br /> ❑ All impervious surfaces at time of application submittal. Checks are <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: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />