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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 Agent Name <br /> Ami & Robert Kreger Robb Remiker, PE <br /> Address Agent Address <br /> 2100 Korgen Drive 5114 Sudbury Way <br /> City,State,zip Stoughton, WI 53589 City,State,zip Madison, WI 53714 <br /> Phone Agent Phone <br /> 608-206-3751 608-358-3556 <br /> E-Mail Agent E-mail <br /> rob.kreger@gmail.com; ami.kreger@gmail.com sudburyconsultants@gmaii.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section 1A NE 1/4 y4 NE Acreage 0.672 <br /> Pleasant Springs/29 <br /> Parcel Number(s) Zoning District <br /> 0611-291-0634-8 Residential <br /> CSM Lot Subdivision Block/Lot <br /> 4 Squire's Rolling Meadows <br /> Project Description <br /> Construct a new house with attached garage, driveway, walk, and deck. <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 ❑No ❑ Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? MNo If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes MNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑ifes ❑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 /> GI 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 /> Robb Remiker Dae:0290324y145o13-0500 3/24/21 <br /> Applicant signature: Date: <br /> H:\Zoning\Shoreland-Wetland Zoning\Chanter 11 Forms\DCPSHL Aonlication.docx Version 1.1 Created 12272013 <br />