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Dane County Shoreland Zoning Zoningofce use,only <br /> Permit Application <br /> Shoreland Permit PSl-IL,- , .�.. <br /> Application must be made in person Zoning Permit#DCPZP-• 1: <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 /> Mark Halverson <br /> Address Agent Address <br /> 3054 Shadyside Drive <br /> City,State,Zip Stoughton, WI 53589 • C• ity,State,Zip <br /> Phone A• gent Phone <br /> 608-279-7620 <br /> E-Mail Agent E-mail <br /> mhalverson @businesstransportation.net <br /> Property/Location Information (http:/)accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 3054 Shadyside Drive Pleasant Springs ��' '�'% .46 <br /> Parcel Number(s) Zoning District <br /> 046/0611-303-6022-1 Dane County <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Screen porch on existing deck, entry columns, gables and shingles. <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? ❑ Yes IONo ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? IINo If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes BNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑ Yes$1No <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 /> o Any proposed structures Please have cash or check payment available <br /> o 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 $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. <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: <br /> —JA5 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />