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Dane County Shoreland Zoning Zoning eke use only <br /> Permit Application Shoreland Permit#: DCPSHL- - <br /> Application must he 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 /> Donna Anderson Champion Window Company of Milwaukee,LLC <br /> Address 2088 Barber Dr Agent Address 16560 W Glendale Dr <br /> City,State.Zip Stoughton, VVI 53589 City,State,Zip Berlin, WI 53151 <br /> PhoneAgentAgent Phone984-224-7926 <br /> E-Mail Agent E-mail y <br /> danderson0329@hotmail.com kalston©championwindow.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section NW Acreage <br /> 2088 Barber Dr Town of Dunn ,� NE y y, 0.185 <br /> Parcel Numbers)028/0610-262-0264-3 Zoning District SFR-08 <br /> CSM Lot Subdivision Block/Lot <br /> 14 Lincoln Park <br /> Project Description <br /> Addition of a gable style three season sunroom on existing concrete slab <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? EA Yes ❑No ❑ Don't Know <br /> Is there a wetland or floodplain on or near the property? ❑ Yes UNo ❑ 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 BNo <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑+01cs ❑No <br /> Most applications must be accompanied by a survey showing the following: <br /> operty lines with dimensions <br /> All existing structures Permit Fee due at time of application <br /> e1'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 /> ❑ 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 /> i <br /> Applicant signature: /���� 1 Dater 2 <br /> 1 <br /> H:\Zonine\Shoreland-Wetland Zonine\Chanter 11 Forms\DCPSHL Annlication.docx Version 1.1 Created 12272013 <br />