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DANE COUNTY ZONING DIVISION ' <br /> CITY COUNTY BUILDING, RM 116 <br /> 210 MARTIN LUTHER ICING, JR. BLVD. ^y�J ' <br /> . ? '; <br /> MADISON, WISCONSIN 53703-3342 • <br /> „ft; <br /> • <br /> PHONE 266-4266 FAX 267-1540 <br /> www.countvofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: /Q1`01.ft O 'Hl7Y►‘(o L L C. AGENT: <br /> ADDRESS: �1 (� ( SC 1ti 1 WY1icoi ADDRESS: <br /> a\(_(9 iscnWT.. S37('3 <br /> PHONE: (.o() PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: S r v e.A.o eon s\--f UL v ; <br /> ESTIMATED COST OF CONSTRUCTION: $ 9 ( (4,.H 0 00 (Structure plus mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 53,C/ALA_60_,o 1OoSt <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/4 1/4 <br /> TAX PARCEL NUMBER <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: G C f ‘--kU VVC)U3 <br /> LOT NUMBER,IF ANY: <br /> 6. ZONING DISTRICT: <br /> 7. SITE PLAN: *A site plan must be drown to scale showing the lot lines and lot dimensions, the locatior, <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. <br /> Example of a Site Plan on reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy will be kept in Zoning Division files <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> STATE SANITARY PERMIT NEEDED? 0 N IF YES, PERMIT# 13-aC L S- (X)3' S <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y IF YES, PROVIDED? Y <br /> � <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y ic)1 IF YES, PROVIDED? Y \✓ <br /> Many Towns require a Driveway Permit;County Highway Department or WDOT permit✓✓✓s may be required for <br /> driveways with access to a County,State or US Highway (I <br /> 11. 5HORELAND? Y/10 FLOODPLAIN? Y(9 WETLANDS Y/01 <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) �� <br />