DCPSHL-2021-00070 - Laserfiche WebLink

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Dane County Shoreland Zoning Zoning office use only Permit Application Shoreland Permit#:DCPSHL- - Application must be made in person Zoning Permit#DCPZP- - Shoreland Zoning Permit fee is$150 A shoreland zoning Permit will be required prior to a general zoning permit being issued by the Dane County Zoning Division for any development within the shoreland district. .f Property Owner Information Agent Information Name - Agent Name Address w„ dress ��e�/ f�� 4, 1014 C� Agent Ad It City,State,Zip S.0 R/� ... t# ' ('A9 /141 CIg•-:i e�-4 J�fr� rl x ;� f City,State,Zip Phone 6y t ,,s Agent Phone 60g.;:-- 19 eM L' E-Mail Agent E-mail �+ :ifitil$ r.! , T 'tel ,\ ti5 i rt) ) Property/Location Information (http://accessdane.co.dane.wi.us) Property Address txTown/Section 1611 09 itj, / y.iv r Acreage tt .?tot-salitApg, 106,14 12 1 oE. Parcel um er s) Zoning District Qc o6ro --v91 --.3/12 3 s F -� CSM Lot Subdivision I Block/Lot °wL�7" Project Description JJ C�_t�s! / //y�r ,�r �j) ` �`�{�yp . ; t-4 6. : £'6'nr7�r ~' � � t; Ai/t t PI 7CCJ i' 7/.;,V k a �" Se';' Please answer the following questions to the best of your ability: Is the property within 300 feet of a stream or 1000 feet from a pond or lake?A Yes❑No ❑ Don't Know Is there a wetland or floodplain on or near the property? ❑ Yes,No ❑ Don't Know Is this project associated with a recent rezone/CUP/variance?,'RNo If yes, petition/appeal# Is this permit to correct a violation? ❑ YesINo Have you contacted the Dane County Land and Water Resources Department about this project9,, ]] Yes ❑No Most applications must be accompanied by a survey showing the following: ❑ Property lines with dimensions o All existing structures Permit Fee due at time of application ❑ Any proposed structures Please have cash or check payment available o All impervious surfaces at time of application submittal. Checks are o All vegetative areas payable to Dane County Zoning. The fee for o Ordinary High Water Mark a shoreland zoning permit is$150.00 and is r o Topographic data(2-foot contours) non-refundable. I,the undersigned, hereby make application for a shoreland zoning permit and certify to the accuracy of the information. I further certify I am the property owner,or a duly authorized representative,and may sign this permit application on the behalf of the owner(s)of said property. Applicant signature: Date: `� ` 4 to f H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL_Application.docx Version 1.1 Created 12272013