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DANE COUNTY ZONING DIVISION •CITY Cowry COUNTY BUILDING, RA 116 , • <br /> • <br /> 210 MARTIN LUTHER KING,a. BLVD. l= r ; <br /> MADISON. 42 en 4 <br /> /KA WISCONSIN 53703 33 <br /> PHONE 266-4266 FAX 267-1540 � `"k? <br /> www.countvofdane.comlzoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: 1i f–A f9 ,LL_(— AGENT: <br /> ADDRESS: (O tP i d e OIL ADDRESS: <br /> Gc ((PP 6'3 – <br /> PHONE: ' 7 IS PHONE: <br /> EMAIL: " EMAIL: <br /> 2. TYPE OF PROJECT: - i - j r / (} <br /> ESTIMATED COST OF CONSTRUCTION: L tructure plUSrnechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: ' L0_, ■ <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SEC770N,1/41/4 • kk <br /> TAX PARCEL NUMBER ] f <br /> SUBDIVISION OR C5M,#`(Certified Survey Map),IF ti t `G < 1 N--/A) <br /> LOT NUMBER,IF ANY: 1 C J 1 <br /> 6. ZONING DISTRfG — -— - �-`�- �� -- ---— — —- — <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 copy wi//be kept in Zoning Division files <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? Ptit-tiA-"-- r. <br /> STATE SANITARY PERMIT NEEDED? CP/N IF YES, PERMIT# ( 3 10 16 O t7O <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y/ IF YES, PROVIDED? Y(N) <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y IF YES, PROVIDED? Y / <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 /> N j <br /> 11. SHORELAND? Y iP FLOODPLAIN? Y WETLA•bS Y/ � <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Squore feet) i / <br />