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DANE COUNTY ZONING DIVISIONt <br /> d'" " <br /> CITY COUNTY BUILDING, RM 116 � +�� <br /> 210 MARTIN LUTHER KING, JR. BLVD. <. <br /> MADISON, WISCONSIN 53703-3342 '4101641 <br /> PHONE 266-4266 FAX 267-1540 4 C <br /> www.countvofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: AGENT: <br /> ADDRESS: ADDRESS: <br /> PHONE: PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: 8 0'10(Z I c Add`tc 0 i'! <br /> ESTIMATED COST OF CONSTRUCTION: $ O C '& <br /> � (Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 11(c' 5. Fi51-1 f-tt,k—rCt-1-=QY R . <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 `I <br /> TAX PARCEL NUMBER [ 509 - C7i./ - 'oc) - 2 <br /> SUBDIVISION OR CSM#(Certified Survey Mop),IF ANY: <br /> LOT NUMBER,IF ANY: <br /> 6. ZONING DISTRICT: 4;72 <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 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? PT v-, 1P P�/S X9 <br /> STATE SANITARY PERMIT NEEDED? Y/® IF YES, 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 to a County, State or US Highway <br /> 11. SHORELAND? Y,B FLOODPLAIN? Y/® WETLANDS Y /I I� <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) 700 <br />