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• <br /> DANE COUNTY ZONING DIVISION -;`rs" <br /> {' • <br /> CITY COUNTY BUILDING. NI 116 <br /> 210 MARTIN WTHES IINW.IR.6LVD. 1 , /G; <br /> MADISON.WISCONSIN 53103-3342 `E ; : • <br /> d••PHONE 266-42M FAX W-1540 .... ,... .. . <br /> www.countvofdane.comlmning . <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE., <br /> 1. LANDOWNER: r` a YJJ( IS LLB-- ACTT: <br /> ADDRESS: r t.eD t. • 111.,...4 • ' ADDRESS: <br /> I•L � )..A .A . , <br /> PHONE: PHONE: <br /> EMAIL: EMS'` <br /> 2. TYPE OF PROJECT: <br /> ESTIMATED COST OF CONSTRUCTION: $ tr�uct+u�e pwus n h call) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: b Vino Couiti <br /> 4. LOCATION OF PROJECT: 'M.J- 11445)/ — . <br /> TOWNSJDP,SECTION,1/41/4 <br /> TAX PARCEL NUMBER <br /> SUBDIVISION O?CSM#(Certified Survey/40p),IPANY: 'J rem_CAP c) (,`6 1,U <br /> LOTM/MBER IF ANY: 1, 0 <br /> 6. zot DE5 cq. <br /> 7. SITE PLAN: *A site plan must be drown to scale showing the lot linas and lot dimensions,the location <br /> and size of all existing and proposed buildings or additions and their distances from <br /> lot lines If the let is not served by public saw. the location and size of the on-site <br /> septic system and the location of the Noll shall be shown on the plan. , <br /> . ample of a Site Plan an reverse. <br /> B FLOOR PLANS AND ELEVATION VIEWS(front, sides, roar): A copy will be kept in Zoning Division fikx <br /> F.xaaples of floor Plans and Els attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SY 1 ? 1�� " <br /> STATE SANITARY PERMIT NEEDED? cy N IF YES. PERMIT# r-O/�` OD/aa-- <br /> APPROVAL FOR ODDS BEDROOM OR > 25%AREA NEEDED? Y() IF YES, PROVIDED? Y 0 <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y le W.YES. PROVIDED? Y/N <br /> Many Tams require o Driveway Permit.. County HIy isay Department or WDOT permits may be required for <br /> ai ivesnys with access too County,State or U.S HO/ow <br /> 11. SWORELAND? Y N FLOODPLAIN? Y 0 WETLANDS Y/Q <br /> 12. TOTAL AREA OF DISTURBANCE(Square fast) <br />