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. v ir !S~ <br /> DANE COUNTY ZONING DIVISION . %' ';'', <br /> O1TY COUNTY BUILDING. RA 116 ' <br /> 210 MARTIN LUTHER KING,JR.BLVD. Vi .e .1 <br /> MADISON.WISCONSIN 53703.3342 _ 1151•1: .,. .. <br /> PHONE 266-4266 FAX 267-1540 <br /> www.countvafdant_con IZoning <br /> ZONING PERMIT CHECKLIST <br /> 4 . <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE, <br /> 1. LANDOWNER: c..1 . 1 ' 12 f y t 1-1--(--- AGENT: <br /> ADDRESS: - ° Oe..ut h_. I L ADDRESS: <br /> MCI `5 ll , Lac c3- 1 <br /> PHONE: (ci -.3 , In -- )/00 PHONE: <br /> EMAIL: EMAIL; <br /> 2. TYPE OF PROJECT: [ - -`- Oil • I .Cep <br /> ESTIMATED COST OF CONSTRUCTION: $ ' (Structure p lusmechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 6411 , COU.A <br /> 4. LOCATION OF PROJECT: 1 <br /> TOWNSHIP,SECTION.1/4 L ,,4 • . - ■ ' vS <br /> TAX PARCEL NUMBER sJ� �� <br /> SUBDIVISION ORC5M#(Certified 5LrIty IF ANY: <br /> m or <br /> LOT NUMBER,IF ANY: Fit <br /> LI- <br /> 6-.----ZONING-ItISTRICT1— ' --— %- <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 seiner, the location and size of the on-site <br /> septic system and the location of the well shall be shown on the plan. <br /> Exanpk of a Site Plan an 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 Elevetlons attached. <br /> • <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? PvisAi-4_ / <br /> STATE SANITARY PERMIT NEEDED? p/N IF YES. PERMIT# (D <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y/0 IF YES. PROVIDED? Y N <br /> 10. DRIVEWAY(ar Culvert or Access)PERMIT NEEDED? Y 0/ 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 U5 Highway <br /> N <br /> 11. SHORELAND? Y FLOODPLAIN? Y 0 WETLANDS Y/0 <br /> DISTURBANCE(Square feat) <br /> 12. TOTAL AREA OF LAND D <br />