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DANE COUNTY ZONING DIVISION >, <br /> dy <br /> CITY COUNTY BUILDING, RM 116 - ■ <br /> •210 MARTIN LUTHER KING JR. BLVD. %U�,> i, `,, <br /> MADISON, WISCONSIN 53703-3342 <br /> :4 IN3Y <br /> PHONE 266-4266 FAX 267-1540 �'?4pC yg--, <br /> www.countyofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: Gt}O b A-0...2- Qp}6E. AGENT: Mc* sc CD e0,T20 c11o10 <br /> ADDRESS: (e 0(o9 =VYIP eAtt AL. 02. ADDRESS: 414 b' OFe-1 a DQ. ("'mac <br /> 0.)PPfuniA e i tiJk 53597 AID l5a 3 W1 5311q <br /> PHONE: 844('D • ‘1937 PHONE: S33 - i t 2.7 <br /> EMAIL: EMAIL: 3r..0monsanlhl)i td tr^s• cc Ili <br /> 2. TYPE of PROJECT: .D`^"'\ aarQ Acta. t-41:6Y1 <br /> ESTIMATED COST OF CONSTRUCTION: $ 32-5i 000 (Structure plus mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 6 t E3.7 _PC?Y- q1 e �c1 <br /> 4. LOCATION 1 HrPSECIO ,, 41/4 kOWA QC" 60c NeYq S IA)!Ai 53 TSNr2% IoE <br /> T A X P A R C E L N U M B E R ON • 0 0 1 0 . 0 33 ' 30 400 <br /> SUBDIVISION O(CSM#( ff�edSurvey Map),IF ANY..' 9 - S 9 <br /> LOTNUMBER,IF ANY: 0-t- 2. <br /> 6. ZONING DISTRICT: H 2. 703 cue z" /b <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 /> 8 FLOOR PLANS AND ELEVATION VIEWS (front, sides, rear): A copy will be kept in Zoning Division files <br /> Examples of Floor Mans and Elevations attached. <br /> 9. PUBLIC SEWER ORIR1ATE SEPTIC SYSTEM?1 /94111: f 3 SD L/79 <br /> 8 / <br /> STATE SANITARY PERMIT NEEDED? Y/N IF YES, PERMIT# 501 <br /> APPROVAL FOR ADDING BEDROOM OR s 25%AREA NEEDED? Y / N IF YES, PROVIDED? Y/N <br /> 10. DRIVEWAY (or Culvert or Access)PERMIT NEEDED? Y F YES, PROVIDED? Y /N <br /> Many Towns require a Driveway Permit;County Highway Department or WDOT permits may be required for <br /> driveways with access to a County, State or US Highway <br /> 11. SHORELAND? Y N / FLOODPLAIN? Y/,N WETLANDS Y N 2 1/-9 <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) ���/ L/S— D SD 0 <br /> l <br />