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Dane County Shoreland Zoning Zoning office use on!;' <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 /> Simeon & Heidi Wolf Seth Ebel <br /> Address 10794 W Hudson Road Agent Address 5201 Fen Oak Drive <br /> City,State,Zip City,State,Zip <br /> Mazomanie, WI 53560 Madison, WI 53718 <br /> Phone Agent Phone <br /> 608-795-4492 608-224-3739 <br /> E-Mail Agent E-mail <br /> wolfpak@centurytel.net seth.ebel@county of dane.com <br /> Property/Location Information (http://accessdane.co.dane.wi.us) <br /> Property Address Town/Section Acreage 40 <br /> 10794 W Hudson 8390005 <br /> Mazomanie ��` sw ��`��` Sw <br /> Parcel Number(s)080608390005 Zoning District <br /> CSM Lot Subdivision Block/Lot <br /> Project Description <br /> Stream bank protection using rock riprap <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? IN Yes ❑No ❑ 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 •No <br /> Have you contacted the Dane County Land and Water Resources Department about this project? ❑U Yes ❑No <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 /> ❑ 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: liege Date: 6/16/2021 <br /> H:\Zoning\Shoreland-Wetland Zoning\Chapter 11 Forms\DCPSHL Annlication.doce Version 1.1 Created 12272013 <br />