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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 2'300' of lake, pond, river or stream ❑ 300' of a floodplain <br /> ❑ A��floodplain ❑ 75' of a wetland ❑ A wetland El The vegetative buffer zone <br /> D-SI oreland Water body: iac-lc �� dentification: o� DNR designated?.Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C _ Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> l Existing ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): Sq Ft <br /> Total Lot: '79'7 SL)--- <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot S9-2 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious -1-- 9 oon , 6 nQ � /z3600 <br /> Percent impervious /, —7°/ <br /> Project meets shoreland standards:,6,Yes ❑No Shoreland zoning permit denied: ❑Yes 1No <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shoreland s •i .permit on hol% for other permits / <br /> Issued by Date / 9 f 'Z <br /> ssistan P'_om A.mmistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />