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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 -x-300' of lake, pond, river or stream 300' of a floodplain <br /> ❑ A floodplain �❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> Shoreland Water body: 7`x-4-47 a Identification: DNR designated?iSrYes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe El General floodplain ❑Flood storage <br /> Lot <br /> ,xisting ❑ Existing non-conforming ENew <br /> Impervious Surface Calculations <br /> • <br /> Area (square feet): Sq Ft <br /> Total Lot: <br /> Within 300' of <br /> ordinary high water <br /> mark Existing Additional Proposed Post Development <br /> Lot 107 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious ) <br /> Total impervious o 3 S <br /> Percent impervious !o , l- ► 3_. °� <br /> Project meets shoreland standards: Yes ❑No Shoreland zoning permit denied: ❑YesNo <br /> Additional Dane County permits needed: <br /> 1'Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit AZoning Permit Cl <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Shore! id zoning permit on hold for other permits <br /> Issued by L _A0 ,dio■ Date <br /> 7/S/L-- <br /> • sistant onmg •• inistrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />