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3 <br />DANE COUNTY ZONING DIVISION 3 <br />QTY COUNTY BUILDIN6, RM 116 ��06 <br />210 MARTIN LUTHER KING. JR. BLVD.MADISON, WISCONSIN 53703-3342 <br />PHONE 266-4266 FAX 267-1540 <br />www. cou ntvofda ne. com/zoning <br />ZONING PERMIT CHECKLIST <br />PLEASE FILL IN AS MUCH INFDRMATION AS PDSSIBLE. <br />1. LANDOWNER: gcD rr--s-• U-) 1I'e'coj AGENT: <br />ADDRESS: 21 ADDRESS: <br />PHONE: (� 15" 179 PHONE: <br />EMAIL: U� I I ��@.� i EMAIL: <br />2_ TYPE OF PROJECT: <br />c.rr_ <br />dl=.3� <br />J N3Yw <br />�CQT3�� <br />ESTIMATED COST OF CONSTRUCTION: S y' facz-A-> S5 <br />3. ADDRESS OF PROJECT, IF KNOWN: <br />4. LOCATION OF PROJECT: <br />TOWN5f4IP, SECTION, 1/41/4 GE4*D1-) —7 <br />TAX PARCEL NUMBER <br />5UBDIt25ION OR C5M # (Certified Survey Map), IF ANY: <br />LOT NUMBER, IF ANY.' <br />6. ZONING DISTRICT: <br />plus mechanicals) <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. <br />Example of a Site Plan on reverse. <br />B FLOOR PLANS AND ELEVATION VIEWS (front, sides, rear): A cop), will be kept in Zoning Division files. <br />Examples of Floor Plans and Elevations attached. <br />9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? f l21 0441r, �940M- <br />STATE SANITARY PERMIT NEEDED? Y / N IF YES, PERMIT # f�c2122I <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? YO N IF YES, PROVIDED? 0 N <br />Many Towns require a Driveway Permit,' County Highway Department or 14/DOT permits maybe required for <br />drivewq)3 with access to a County, State or, Ll -5 Highway <br />geo <br />11. SHORELAND?V N FLOODPLAIN? Y /O WJ ETLAND. r C <br />�j <br />12. TOTAL AREA OF LAND DISTURBANCE (Square feet) ICD I <br />