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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL-I7 - <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 /> Daniel and Nicole Cardamone Marten Building <br /> Address Agent Address <br /> 931 Harper Drive P.O. Box 64 <br /> City,State,Zip City,State,Zip <br /> Verona, WI 53593 Sun Prairie,Wl <br /> Phone Agent Phone <br /> 312-401-3444 608-212-6934 <br /> E-Mail Agent E-mail <br /> nicolem.cardamone @gmail.com randy @martenbuilding.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section SE NW Acreage <br /> ` 459 <br /> TO6NR10E/S9 � `�` <br /> Parcel Number(s) Zoning District <br /> 028/0610-092-7261-0 R-3 <br /> CSM 1 2377 Lot 1 Subdivision - Block/Lot <br /> Project Description <br /> Residential lot <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 ENo ❑ 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 8No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑Iles ❑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 /> ❑ All vegetative areas payable to Dane County Zoning. The fee for <br /> o 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 /> g-t‘e-%Applicant signature: �"' Date: 6 ,y 7 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms'\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />