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DANE COUNTY ZONING DIVISION • <br /> CITY COUNTY BUILDING, RM 116 <br /> 210 MARTIN LUTHER KING,JR. BLVD. !=' • d" <br /> MADISON,WISCONSIN 53703-3342 <br /> • <br /> PHONE 266-4266 FAX 267-154+7 «•�.,stt_ _ <br /> WWW.countvofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: 1410es; AGENT: <br /> ADDRESS: `J ?tittikl oiditie OR ADDRESS: <br /> i4.501 1.3 <br /> PHONE: (t) PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: V) j C� .. .P , ... c <br /> ESTIMATED COST OF CONSTRUCTION: .;5 `" i L 2(S cture plus mechanicals, <br /> 3. ADDRESS OF PROJECT, IF KNOWN: )Y11A.-zlik" Oft' C-C-Ik, <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 C��� , 1, - <br /> TAX PARCEL NUMBER -, 1 <br /> SUBDIVISION ORCSM#(Certified5urv�eyMap),IF�lNY <br /> I I" ` /" <br /> LOT NUMBER,IF ANY: �V <br /> 6 ZONING DISTRICfr-- <br /> 7. SITE PLAN: "ri 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 Plans and E7evntions attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? P1}-4A-"-. <br /> STATE SANITARY PERMIT NEEDED? Y/ N IF YES, PERMIT#• i.C7/ DQ O I V <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y/ 1 IF YES, PROVIDED? Y N� <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y IF.YES, PROVIDED? Y/6:-.1") <br /> /4any Towns require a DrivewvyPermit;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 Nr� FLOODPLAIN? Y WETLANDS Y/ <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Squire feet) <br />