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Dane County Shoreland Zoning Zotivecauaepnly. <br /> Permit A pp lication t rtiel .i (7�shareland •Permi . <br /> G <br /> Application must be made in person Zoning Permit#-4'K l? '• <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 Agen ame <br /> Ryan Baxter � e,.-.s5,�. ck /1J cv.....-0Z,....S <br /> Address Agent Address <br /> 4030 Mandan Crescent <br /> City,State,Zip City,State,Zip <br /> Madison, WI 53711 <br /> Phone Agent Phone <br /> (608)209 5654 <br /> E-Mail Agent E-mail <br /> rf.baxter @kayseronline.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 4717 County Highway M Town of Westport/05 '/4 NW y,y, SW 2.538 <br /> Parcel Number(s) Zoning District <br /> 066/0709-053-2011-8 ETZ <br /> CSM Lot Subdivision Block/Lot <br /> 1 Fox Bluff, Assesor's Plat Outlot 1 <br /> Project Description <br /> Construction of a new home,driveway,&patio and removal of an existing boathouse within 300'of Lake Mendota. <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? B Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? MI Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance?BNo If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes EiNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑+Pres ❑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 /> ❑ 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 /> Applicant signature: Date: i a'ua C2 lam_ <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />