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DaneCounty Shoreland Zoning Zoning office use only od�� <br /> Permit Application <br /> 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 /> NameWeS Waite Agent Name <br /> Address2256 Hwy AB Agent Address <br /> City,State,Zip City,City,State,Zip 53558 <br /> PhoneAgent212 9611 Agent Phone <br /> E-MailAgent E-mail <br /> drjwaite@hotmail.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address2256 Hwy AB Town/Section y, SE '/.y, NW <br /> Acreage <br /> Parcel Numbers,0610-232-7089-8 Zoning District SFR 08 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Due to aging wood on deck, external wood (non structural) is being replaced in current configuration <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? ❑ 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 IR No <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 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 /> Applicant signature: 7/- .e-a--- O ' (i✓ Date: 5--01- "1 — 02 / <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />