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Dane Count' Shorelandon .n - - y § . <br /> Permit Application <br /> Application must be made in person <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 shot-eland district. <br /> Property Owner Information Agent Information <br /> Name /! Agent Name <br /> %�KIDR6 i (joETz. <br /> Address I Agent Address <br /> 7i`t i i P i EY RD. — –City,State,Zip City,State.Zio <br /> SAVK 6.17Y v.I 535% <br /> Phone <br /> c2 Agent Phone <br /> 608-20-97$7 _ <br /> E-Mail Agent E-mail <br /> yeti'Fin i4J1i 1.1,2.;1.Loin <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/SectionAcreage <br /> 1,1 E. v.y. J,l tA1 <br /> RD. Z.OXtiogY 0_7 <br /> Parcel Number(s) Zoning District <br /> SEc 21-q-7 AZT NE./y I4t4 fy 60M 715 Ft JFK -a8 <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> 5co Sq' tbM G' /10D lTIoN <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?1 .Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes ❑No X Don't Know <br /> Is this project associated with a recent rezone/CUP/variance?KNo If yes. petition/appeal it <br /> Is this permit to correct a violation? ❑ YesNo <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 /> u 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: 0 )D Date: 5/3' I <br /> H:\Zoning Shoreland-Wetland Zoning\Chapter 11 Formis\JDCP51Ii_Applieation.docs Version 1.1 Created 12272013 <br />