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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: Ni 1n e - Q Identification: S DNR designated? 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 /> (22 <br /> l �d <br /> Driveway <br /> Any other impervious <br /> Total impervious <br /> Percent impervious <br /> Project meets shoreland standards: -Yes ❑No Shoreland zoning permit denied: ❑YesJNo <br /> Additional Dane County permits needed: <br /> ,['Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑VVariance <br /> ❑Floodplain development permit ❑ Zoning Permit O f/ u7 / -0 Lti,✓1 <br /> Additional information required: <br /> STATUS: 'Shoreland zonin permit and/or zoning permit issued contingent upon other permits <br /> ❑ or and zo ' p mit on hol for other permits <br /> Issued b/ Date <br /> Assistant Zoning Administrator <br /> H:AZoningAShoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Applicat ion docx Version 1 I Created 12272013 <br />