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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 /> Eric Fisher same <br /> Address Agent Address <br /> 6454 Hyslop Road same <br /> City,State,Zip City,State,Zip <br /> Waunakee, WI 53597 same <br /> Phone Agent Phone <br /> 608.770.6933 same <br /> E-Mail Agent E-mail <br /> fisher.ericm@gmail.com same <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address 6454 H SAO Road Town/Section y4 sw y,y SE Acreage 2.1 2 <br /> Y p Dane/35-9-8 <br /> Parcel Number(s) Zoning District <br /> 022/0908-354-9000-1 RR-2 <br /> CSM Lot 1 Subdivision N/A Block/Lot <br /> 04430 N/A <br /> Project Description <br /> I <br /> ADDITION AND RENOVATION TO EXISTING HOME LOCATED AT 6454 HYSLOP ROAD, WAUNAKEE,WI. <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 8 Don't Know <br /> Is this project associated with a recent rezone/CUP/variance? •No If yes, petition/appeal# <br /> Is this permit to correct a violation? ❑ Yes UNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑ Yes 0110b <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 /> LiTopographic 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. <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 /> Eric Fisher. Eric Fisher <br /> Applicant signature: 2020.04.13 16:36:24-05'00' Date: 4/13/2020 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Application.docx Version 1.1 Created 12272013 <br />