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1)45_.e. 2,0719 5• <br /> ik �3�' 3 ` L113 <br /> . V <br /> DANE COUNTY ZONING DIVISION 5 I / 9f ,,, <br /> 43 r vQ . d ,\\a <br /> CITY COUNTY BUILDING, RM 116 d` �', �1s <br /> 210 MARTIN LUTHER KING, JR. BLVD. t , <br /> MADISON, WISCONSIN 53703-3342 1 ! ; <br /> PHONE 266-4266 FAX 267-15.40 ;lsCg_ <br /> WWw.countyofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: (_����L 1' L <br /> L14.1. •6 <br /> ADDRESS: 6 6. ,c) ,— " IY/1"�9/Nt E : A I .1r_� _ — <<A <br /> Gc// S 3...5 7.4 /- ' <br /> _ 1 -55- 7 <br /> PHONE: Er r L 76 02 PHONE: i5'— S65 a <br /> EMAIL: EMAIL: � Cl <br /> 2. TYPE OF PROJECT: ,A j„u}_ 1 <br /> ESTIMATED COST OF CONSTRUCTION: $ <br /> 475, 0 (Structure plus mechanics/s) <br /> , 1411/1/042141 41Ae-Err 6001146‘ <br /> 3. ADDRESS OF PROJECT, IF KNOWN: <br /> 4. LOCATION OF PROJECT: �'^ „ <br /> TOWNSHIP, SECTION,1/41/4 (/� P' ' ���L(e r7 �f <br /> TAX PARCEL NUMBER OG U o , 3°.2.9, ©— 0 <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY. /V C ZAi' l�/ <br /> LOT NUMBER,IF ANY: <br /> 6. ZONING DISTRICT: L-76 h \ <br /> 7. SITE PLAN: *A site p/an must be drawn 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 P/an 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? � € 1 /Zejee' <br /> STATE SANITARY PERMIT NEEDED? Y 613 IF YE , PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y / N IF YES, PROVIDED? Y/ N <br /> 10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED? Y )IF YES, PROVIDED? Y / N <br /> Many Towns require a Driveway Permit;County Highway Department or WDOTpermits may be required for <br /> driveways with access too County, State or US Highway <br /> 11. SHORELAND? Y 0 FLOODPLAIN? 0 WETLANDS Y / N? <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) '<')r <br /> ...,..." <br />