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ZONING OFFICE USE ONLY ZONING OFFICE USE ONLY <br /> Poject includes development within: (check all that apply) <br /> I/1.000' of a lake or pond L 300' of lake, pond, river or stream d300' of a floodplain <br /> ❑ A floodplain �5' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> sNowAlog,pE2swov <br /> EKhoreland Water body: /cc- /,4 14 if Identification: DNR designated? ❑Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland <2 acres <br /> 55G 0270 F= <br /> ❑ Floodplain FEMA map panel: 550€ Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Loft <br /> �fExisting ❑ Existing non-conforming ❑New <br /> Impervious Surface Calculations <br /> Area (square feet): //6 0,32 Z Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 2 48, 161 <br /> Primary building <br /> footprint O t a52.a P 19 S 2s F <br /> Accessory building(s) <br /> 0 0 0 <br /> Driveway S 338 s F S338s P <br /> Any other impervious o 0 0 <br /> Total impervious O 724 0 s P 72405 r <br /> Percent impervious 2.q N 2.g+ <br /> Project meets shoreland standards: ❑Yes ❑No Shoreland zoning permit denied: ❑Yes ❑No <br /> Additional Dane County permits needed: <br /> ['Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit afioning Permit ❑ <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shoreland zoning permit on hold for other permits <br /> Issued by Date <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />