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Dane County Shoreland Zoning Zoning office use only Permit Application Shoreland Permit#:DCPSHL- - - Application must be made in person Zoning Permit#DCPZP- Shoreland Zoning Permit fee is$150 A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County Zoning Division for any development within the shoreland district. Property Owner Information Agent Information Name Rich Armbrust Agent Name concrete results Ilc 4 ✓I he/So P Address 2307 Williams point drive Agent Address 7210 Branford lane east City,State,Zip Stoughton, WI 53589 Cam,State,ZiPMadison, WI 53717 `we630-710-3040 Agent Phone608-434-6138 E-mail Agent E-mail concreteresultslIc @gmail.t,o,- Property/Location Information (http://accessdane.co.dane.wi.us) Property Address Town/Section Acreage 2307 Williams pleasant springs „, '%'% .339 Parcel Number(s) Zoning District e567 wr/Ir.,-g /b I' df CSM Lot44 Subdivision Block/Lot °GU is/ nil-IL Project Description Replace timber retaining wall with concrete block reta Please answer the following questions to the best of your ability: Is the property within 300 feet of a stream or 1000 feet from a pond or lake? B Yes ❑No ❑ Don't Know Is there a wetland or floodplain on or near the property? ❑ Yes El No ❑ Don't Know Is this project associated with a recent rezone/CUP/variance? No If yes, petition/appeal# Is this permit to correct a violation? ❑ Yes No Have you contacted the Dane County Land and Water Resources Department about this project? ❑Ries EINo Most applications must be accompanied by a survey showing the following: ❑ Property lines with dimensions ❑ All existing structures Permit Fee due at time of application ❑ Any proposed structures Please have cash or check payment available ❑ All impervious surfaces at time of application submittal. Checks are ❑ All vegetative areas payable to Dane County Zoning. The fee for ❑ Ordinary High Water Mark a shoreland zoning permit is $150.00 and is ❑ Topographic data(2-foot contours) non-refundable. I,the undersigned,hereby make application for a shoreland zoning permit and certify to the accuracy of the information. I further certify I am the property owner,or a duly authorized representative,and may sign this permit application on the behalf of the owner(s)of said property. Applicant signature: ' Date: 4/25/201 8 H:\Zoning\Shoreland-wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013