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<br /> DANE COUNTY ZONING DIVISION ___1e,
<br /> CITY COUNTY BUILDING,RM 116 �'ti 46
<br /> 210 MARTIN LUTHER KING,JR.BLVD.
<br /> MADISON,WISCONSIN 53703-3342 ° 0 ' `f$f
<br /> PHONE 266-4266 FAX 267-1540 '
<br /> www.co.dane.wi.us r.
<br /> r 1839.
<br /> ZONING PERMIT CHECKLIST ``Asd g '
<br /> Z-F I '2-A- ..74p6.,..
<br /> 1. LANDOWNER: '17,,t,/►,,,t K,,„t,"( ,,;N AGENT:
<br /> ADDRESS: '73 S iltd, w.t t t,._, pa- ADDRESS:
<br /> Braci,,rc_-Ly N ur (,/___ �j5
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<br /> PHONE: () L/, LW,1 (c PHONE:
<br /> EMAIL: EMAIL:
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<br /> 2. DESCRIPTION OF PROJECT: Mit 1't u,v ' $11.-e e
<br /> ESTIMATED COST OF CONSTRUCTION: $ 500 0, `c (Structure plus mechanicals.)
<br /> 3. ADDRESS OF PROJECT,IF KNOWN: 73 S 11,441 4 f, I I v k.: ,e( 3,,e OC)k l y✓) ki r -5Th s a I
<br /> 4. TAX PARCEL NUMBER(as listed in AccessDane or on tax bill: e)`E7 I 0 —e%-- —0 32O-- 6
<br /> 5 LOCATION OF PROJECT: 7 .b kldy... LUAU/ix) Rd/ /32eck I A} G,„Z
<br /> TOWNSHIP,SECTION,1/4 1/4 3 5" t — � I 0 E 7'u A,•`, 0 l' guTI•A Ai
<br /> d DA",t .
<br /> I N f
<br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: C 3-
<br /> 6 I"1
<br /> LOT NUMBER,IF ANY: '
<br /> /./. ZONING DISTRICT: A I )(Cj(.t S i'd.,e_-
<br /> 7. SITE PLAN: *A site plan must be drawn to scale showing the lot lines 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 lot is not served by public sewer,the location and size of the on-site
<br /> septic system and the location of the well shall be shown on the plan.Site plan must be signed and dated.
<br /> Example of a site plan on back side of this form.
<br /> 8. FLOOR PLANS AND ELEVATION VIEWS(front,*1 copy of floor plans will be kept in the Zoning Department files.
<br /> ✓ Examples of Floor Plans and Elevations attached
<br /> J 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? ,v ft Fr t d 0
<br /> STATE SANITARY PERMIT NEEDED? Y I G� IF YES,PERMIT#
<br /> APPROVAL NEEDED FOR ADDING BEDROOM OR>25%AREA? Y /® IF YES,PROVIDED? Y /Q
<br /> (approval letter from Dane County Environmental Health-608.242.6515)
<br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y /€ IF YES,PROVIDED? Y /®
<br /> Contact County Highway Department for County Highway Access Permits(608)266-4261.
<br /> Contact DOT for access permits on State and Federal Highways(608)246-3800.
<br /> *Towns requiring Driveway Permits are:Albion,Berry,Blooming Groove,Blue Mounds,Burke, Cottage Grove,Deerfield,Dunkirk,
<br /> �Dunnnn,Mazomanie,Montrose,Oregon,Perry,Pleasant Springs,Primrose,Roxbury,Rutland,Springdale,Springfield,Sun Prairie.
<br /> 1� S /C RELAND? Y FLOODPLAIN? Y ,l I WETLANDS? Y ,C ,
<br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) I /t) S • 'r
<br /> *If disturbed area is greater than 4000 square feet,or is located near a lake,pond,river or stream you may4 eed an erosion control
<br /> permit. Please contact Land Conservation at(608)224-3730.
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