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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 ,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:1-0/c Cie 2-k Identification:- 5f4 o DNR designated? 1 Yes ❑No <br /> ❑ Wetland ❑ Shoreland wetland ❑Inland wetland ❑Wetland<2 acres <br /> ❑ Floodplain FEMA map panel: 55025C Flood zone: <br /> ❑Floodway ❑Flood fringe ❑General floodplain ❑Flood storage <br /> Lot <br /> ❑Existing ❑ Existing non-conforming New <br /> Impervious Surface Calculations <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 <br /> Primary building <br /> footprint <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious Sc��o J. <br /> ^ <br /> Percent impervious , S Q <br /> Project meets shoreland standards: >4 Yes ❑No Shoreland zoning permit denied: ❑Yes NNo <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit 1$ Zoning Permit ❑ <br /> Additional information required: <br /> STATUS: ❑ Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> Shoreland aping perm' on hold for other permits <br /> Issued b Date JOS/ ' <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />