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I D County <br /> Permit Application ,_. t( t ' `4l?rE <br /> A i licatir� Amin*Perini' l :PZP _ -- <br /> 1 Ft rt OW! .�made inn r_s it;i its t .' [)atr �a"# ;1,, i;s=3 <br /> Shtureland Zoning Permit feels Si c0 <br /> A shorelantl inning l'crmit will be required prior to a general zoning permit being issued by the Dane County <br /> Zoning Division for anv-development within the shoreland district. <br /> Property Owner information Agent Information _ <br /> Nares Agent Nam t {1 t€ L <br /> Ado-es5 Agent f\ eres6 -t L`.�"�'4+e l�t2l <br /> I - ;l r'4O f.S ` ` iC v4c�`'v � +�/ <br /> I City.State,Zip fir.Stale.Zia . j <br /> ____3-1,>'-21_-:-;(17 � M/r �,/1„/ t <br /> Phone Agent Phone ;r. 'G Z <br /> l? . <br /> E-Mat1Agent L.rt �6 �G, '��`%AtC ' <br /> 1 d i4 VL5 /eC 7"}� X'iC.7Zu $,e ✓C":�/4C 3 !�1.�O c 9'th <br /> Property{Location Information (http:iaccossdano.co.dane.wi.us) <br /> Propetty Ac:&e s 1 Tawn.5ection17 57 /444/45 crj, Lia-ip6e-r % %% i APatase,_ `., : I <br /> . <br /> ..t Nurnhens} Zoning astnct <br /> Lei [siviion <br /> 1 Bkvdtot <br /> . <br /> m moo. ^.n=..m.. <br /> Project. Description <br /> zii/,± d ,ar- 1`nr ;'{>i-su iC0c /t'77-0/tJ , 5 ,/ CII <br /> _lit,C1 i 6 S/7 fttt7L' <br /> Please answer the followlnQ questions to the best of your ability: r <br /> 6 the propk-rty within 300 feet of a streisrt or I OO()feet from a pond or lance? Yes ONo L)on`i Know <br /> is there a wetland or tlo�odplain on or near the p" 'n` Yeti ;lio .i Dot't Know <br /> Is his project:tsiCci2ted with a recent re ono'CUP'ti dri'.!nc:.-?IgNt) if yes, petition appcai Ra <br /> it <br /> thitz penult to correct t1 violation'? 12 Yes iL.iNuv i <br /> 11:v;'yk-u contacted the I),sste County Land and Rater Resines fie iinent about this project? <br /> Yes Jti�v <br /> Mosta •Iications must be accom.^hied b a su a sho n t, the foilowin <br /> U Property tines with dimensions Permit Fee due at time of application <br /> ci l cpistin;structures Please have cash or check payment available <br /> Any propOSed structures at time of application submittal. Checks are <br /> L All impervious surfaces payable to Dane County Zoning. The fes for <br /> a All vegetative areas a shoreland zoning permit is 5150.00 and is <br /> 3 Ordinary High Water Mark non-refundable: <br /> u Topo<Traphic data(2-loot contours) <br /> ,cam tar a$p eltinci z +�Peretti arVJ cattily to the accuracy of the i€tfort , rn I <br /> ft, 1+r,�.tj, ,onsi niaku app' lr" representative..9r1Ci rill 4 r1 thl$permit E ft c y In am ti-to prope.rtY v.tnor,ora duty authorized y,'9 p_z p} tion cn the <br /> bunt.111 Of the owner(s)of said rrorterty - <br /> -y <br /> � ._ eat*: / 2L./ <br /> Applicant s;gnatum -..-_ -�,_.-- <br /> ---- .,..s. *-tl:uid lcccu:.Lii:u;irrr;t trtiit.,Ln.Sttl._Ap-ouc4tion&wit Vc:11;"1 1 Cluu:cd 12272013 <br />