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Dane County Shoreland Zoning ning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- - <br /> Application must be made in person Zoning Permit#DCPZP- - <br /> Shore land 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 Alexander/Jennifer Kobryn Agent Name <br /> Address Agent Address <br /> 2071 River Estate Lane <br /> City,State,Zip Stoughton, 'NI 53589 City,State,Zip <br /> Phone Agent Phone <br /> 608-393-0808 or 262-442-8972 <br /> E-Mail. Agent E-mail <br /> glotocha @yahoo.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 2071 River Estate Lane 6N/11 E 1/, NE y,y, NE 1 .61 2 <br /> Parcel Number(s)046/0611 -291 -8415-7 Zoning District R-1 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> 6=07 <br /> Extend deck from about 235 square feet to) square feet. Project is located over 230 feet from the shore line. <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? 8 Yes ❑No ❑ 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? .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? ❑files ❑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 /> ❑ All impervious surfaces at time of application submittal. Checks are <br /> payable to Dane County Zoning. The fee for <br /> ❑ All vegetative areas <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: �S/I <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter I I Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />