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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 /> James Newton & Debra Wied Newton Stephanie Kleckner, Ambiance Homes, Inc <br /> Address Agent Address <br /> 1201 Dynes Way 5833 Grassland Terrace <br /> City,State,Zip City,State,Zip <br /> Sun Prairie, WI 53590 Marshall, WI 53559 <br /> Phone Agent Phone <br /> 608-516-6068 608.225.4594 <br /> E-Mail, Agent E-mail <br /> jamnewto@cisco.com ambiancehomesinc@charter.net <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Fissure Trail Tow % NE %y, SWnAcreage.66 <br /> Parcel Number(s) Zoning District <br /> 0911-121-4075-0 <br /> CSM Lot Subdivision Block/Lot <br /> Drumlin Creek 25 <br /> Project Description <br /> Construct a single-family home. <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? B Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes BNo ❑ 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 IONo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑fires ❑No <br /> Most applications must be accompanied by a survey showing the following: <br /> u Property lines with dimensions <br /> to 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 /> u 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: �� /1� Date: 4-28-2021 <br /> H:\Zonine\Shoreland-Wetland Zoning\Chanter 11 Forms\DCPSHL Annlication.docx Version 1.1 Created 12272013 <br />