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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- / - <br /> Application must he 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 /> Brian and Kate Monson <br /> Address Agent Address <br /> 3185 Timber Lane <br /> City,State,Zip City,State,Zip <br /> Verona, WI 53593 <br /> Phone Agent Phone <br /> (608)334-2867 <br /> E-Mail Agent E-mail <br /> k8monsonl@gmail.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address 3185 Timber Lane Town/Section y %Y.NW NE Acreage 3.6(Approx.) <br /> Town of Verona/06 <br /> Parcel Number(s) Zoning District <br /> 0608-062-8400-0 RH-1 10 e <br /> CSM Lot Subdivision Block/Lot <br /> 12966 1 N/A N/A <br /> Project Description <br /> Removal of art existing house and driveway and construction of a new house and driveway. <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 0 Don't Know <br /> Is there a wetland or floodplain on or near the property? 8 Yes ENo ❑Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? If yes. petition/appeal# <br /> Is this permit to correct a violation? 0 Yes E INo <br /> Have you contacted the Dane County Land and Water Resources Department about this project?43 if L-1.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 /> ca <br /> 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$1 50.00 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 owners)of said property. 7/17 <br /> Applicant signature: —e �� Date: 7/ <br /> 11.\Zoning\Shoretand-Wetland Zoning',Chapter 11 Forms:DCPSHL_Application docx Version 1.1 Created 12272013 <br />