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. , <br /> DANE COUNTY ZONING DIVISION <br /> .. . , <br /> 1 <br /> CITY COUNTY IIRLDIN0. II 116 ,..,. <br /> .. <br /> . <br /> 210 MARTIN WI let 21146,R.IUD. 5, <br /> • <br /> MADISON.WIICOPMIN 53211-3342 <br /> PHONE 266-4M6 FAX 167-1540 F,,„ ' .-•. .. el. <br /> MatelAgatedantsenfigft :"./.;''''--M.- -: <br /> ZONING PERMIT CHECKLIST <br /> PLEASE EnkailmustuNEOSEMALIMM <br /> 1. LANDOWNER: VglEA D I owl ittritsi) AGENT: <br /> ADDRESS: 122012016311L–TM16WILDIAAL ADDRESS: - <br /> M401Nowl I 14 i Silles <br /> PHONE: font • 224... f tsC5 PHONE: <br /> BUIL: EMAIL: <br /> 2. TYPE CIF PROJECT: i. Air /0 <br /> ESTIMATED COST OF CONSTRUCTION: $ A- 4 / (Structure plus mochankals.) <br /> r / <br /> 3. ADDRESS OF PRO.7ECT.IF ICNOWN: ___212+1,911210:21/D112A1/44( <br /> 4. LOCATION OF PROJECT: <br /> rowivom SECITOAL 1/41/4 e*—in ua t4 OF kil)1 ejenobcde„.. <br /> TAX PARCEL WAVIER <br /> SLSOIVISION OR CS41 el(Certified SerwAlop2 IF ANY:______..14-Dag —E2-1-57 <br /> LOT WAINER IF ANY: &. 5— <br /> 6. ZONA*DISTRICT: jj1L11:50r.„.0.1 <br /> 7. SITE PLAN: *A site plan must be drawn to seek shard'',the lot lines and lot dimensions;the location <br /> and size of all exist*end proposed buildings or adcbtions and their distances fran <br /> – lot knee If the lot is not served by public semer,the location and size of the on-site <br /> septic system and the location of the well shal I be shown on the plan. • <br /> &earl s of e Ste Plan en reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front.Mak rear): A cop y re I be kept i amiq Dii film <br /> Emetyks of Moor Maas and Elevatins e -died. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> STATE SAMMY MUT NEEDED N IF YES. PERMIT X S :3 G,G, <br /> APPROVAL FOR ADDING BEDROOM àR s 25%AREA NEEDED? Y/ ) IF YES. PROVIDED? Y/101 <br /> 10. DRIVEWAY(w Wm"or Anus)PERMIT NEEDED? Y N IF YES, PROVIDED? Ye <br /> *any Towns require a Drivemay Peewit Cbunty Mpineay o r 1VDOT penalty may be required far <br /> driveways with acceer to a ebim State or U.5 Highway <br /> 11. MORELAND? Y FLOODPLAINT Y(2) V/ETLANDS Y f4?) <br /> 12. TOTAL AREA OF DISTURBANCE(Swore fore <br />