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T` Dane County Shoreland Zoning Zoning ofceuse only <br /> Permit Application Shoreland Permit#:DCPSHL- - <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 /> Michael Hocking Todd Barnett <br /> Address Agent Address <br /> 4964 Hickory Trail 118 North Breese Terrace, Suite 1 <br /> City,State,Zip Middleton, WI, 53562 City,State,Zip Madison, WI 53726-4133 <br /> Phone 815-481-1368 Agent Phone(608) 266 4538 <br /> E-Mail Agent E-mail <br /> mrhocking @gmail.com todd @barnettarchitecture.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address 4964 Hickory Trail 08/31 Town/Section 14 SW 1�4 y, SE Acreage 1 .53 <br /> Parcel Number(s) Zoning District <br /> 056/0808-313-6203-3 <br /> CSM Lot 3 Subdivision Block/Lot <br /> Project Description <br /> Remove portion of the existing deck and build a 168 sqft addition to the existing house within 300 ft of a navigable waterway. <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? U Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes @No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? @No If yes, petition/appeal# <br /> Is this permit to correct a violation? El Yes UNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? El+lies EINo <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 er,or a duly authorized representative,and may sign this permit application on the <br /> behalf of the owner(s)of said <br /> Applicant signature: � Date: 2 <br /> H:1Zonina\Shoreland-Wetland Zoning\Chanter 11 Forms\DCPSHL Anvlication.docx Version 1.1 Created 12272013 <br />