Laserfiche WebLink
Dane County Shoreland Zoning 2ning office use only <br /> Permit Application Shore land Permit#:DCPSH,- .. <br /> 7 <br /> q Q <br /> Application must be 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 Summers <br /> Address Agent Address <br /> 2828 Waubesa Ave <br /> City,State,Zip City,State,Zip <br /> Madison, WI 53711 <br /> Phone(608) 513-3715 Agent Phone <br /> E-Mail Agent E-mail <br /> bsummers @jfahern.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address 2828 Waubesa Ave Town/Section % NW %% SE Acreage 0.21 3 <br /> Dunn/08 <br /> Parcel Number(s)028/0610-082-1633-0 Zoning District <br /> CSM 13303 Lot 2 Subdivision Block/Lot <br /> Project Description <br /> Removal of existing house, garage, and patio. 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? B Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? B Yes ❑No ❑Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? RNo 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? ❑+lies ❑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: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />