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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 4300' of lake,pond, river or stream ❑ 300' of a floodplain <br /> ❑ A floodplain ❑ 75' of a wetland ❑ A wetland ❑ The vegetative buffer zone <br /> t Shoreland Water body: Identification: 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 /> PExisting ❑ 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 _7C) <br /> Primary building <br /> footprint " <br /> Accessory building(s) <br /> Driveway <br /> Any other impervious <br /> Total impervious 5-Zs %°\ <br /> Percent impervious -7, -7 , /Q <br /> Project meets shoreland standards:Wes ❑No Shoreland zoning permit denied: 0Yes-19,No <br /> Additional Dane County permits needed: <br /> Shoreland Erosion Control Permit ❑ Shoreland Mitigation Permit ❑Variance <br /> ❑Floodplain development permit ❑ Zoning Permit ^L3 0 c <br /> Additional information required: 1 L4 S t <br /> STATUS: Ar Shoreland zoning permit and/or zoning permit issued contingent upon other permits <br /> ❑ Shoreland n g permit on hod for other permits i <br /> Issued by - --- Date 6/6-7/f <br /> E <br /> Assistant Zoning Administrator <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />