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Dane County Shoreland Zoning Zoning office use 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 Pamela S Ivers Agent Name <br /> Address5621 Rankin Lane Agent Address <br /> City,State,Zip Waunakee, WI 53597 City,State,Zip <br /> Phone 608-235-5482 Agent Phone <br /> E-Mail Agent E-mail <br /> pamelasg @charter.net . <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 5621 Rankin Ln Waunakee,WI 53597 Westport % %% •602 <br /> Parcel Numbers>066/0809-211-2249-8 Zoning District <br /> Waunakee/Westport Joint Planning Area <br /> CSM Lot Subdivision Westport Heights Block/Lot109 <br /> Project Description <br /> Erect a 8' x 12' Shed behind the garage <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? B Yes ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? BNo If yes, petition/appeal# . <br /> Is this permit to correct a violation? ❑ Yes BNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑ Yes ❑No <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 p erty owner,or a duly authorized representative,and may sign this permit application on the <br /> behalf of the owner(s) f sal property. <br /> Applicant signature: .` _ €,+,GA Date: <br /> spa'41ff <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013 <br />