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Dane County Shoreland Zoning Zoning office use only <br /> Permit Apphcation 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 CHC Properties LLC Agent Name <br /> Address Agent Address <br /> 201 Business Park Circle <br /> City,State,ZipStoughton, WI 53589 City,State,Zip <br /> Phone608-225-8053 Agent Phone <br /> E-Mail Agent E-mail <br /> Keith @clark-heating.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage <br /> 3080 Shadyside Drive TO6NR1 1 E/S30 y, SE '%`i SW 0.28 <br /> Parcel Number(s)046/0611 -303-6131 -9 Zoning District R-3 <br /> CSM Lot Subdivision Block/Lot <br /> 11 Shadyside Park <br /> Project Description <br /> Residential lot <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? 8 Yes ENo ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? MINo 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? ❑ores ❑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 /> ca <br /> High Water Mark a shoreland zoning permit is $150.00 and is <br /> ID 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 owner,or a duly authorized representative,and may sign this permit application on the <br /> behalf of the owner(s)of said p pe . <br /> .� /�/B <br /> Applicant signature: �� /� Date: <br /> H:\Zonine'4Shoreland-Wetland Zonine\Chanter 11 Forms\DCPSHL Aoolication.doca Version 1.1 Created 12272013 <br />