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Dane County Shoreland Zoning Zoning office use only <br /> Permit Application Shoreland Permit#:DCPSHL- I - 1/b <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 /> Dane County Parks Alex DeSmidt <br /> Address Agent Address <br /> 5201 Fen Oak Drive 5201 Fen Oak Drive <br /> City,State,Zip City,State,Zip <br /> Madison, WI 53718 Madison, WI 53718 <br /> Phone Agent Phone <br /> 608.224.3730 608.221 .7212 <br /> E-Mail Agent E-mail <br /> desmidt.alex @countyofdane.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 7300 SOUTH TOWNE RD 07N/30 &31 % SW y,y SE <br /> Parcel Number(s) Zoning District <br /> 071030490000,071031380001,071031385006,071031387200 Shoreland <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Resurfacing of the Capital City Trail <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? 8 Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? N 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 MNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? El fires ENo <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. <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 /> DeSmidt, Alex DigitallysignedbyDeSmidt,Alex 6/1 5/1 8 <br /> Applicant signature: Date:20113.06.15 13:42:43-05'00' Date: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version L I Created 12272013 <br />