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DANE COUNTY ONING PERMIT CHECKLIST <br /> 210 Martin Luther King Jr.,Bllvd.,Room 116 Madison,WI 53703(608)266-4266 <br /> 1. LANDOWNER: Cu S S°i bra T V L AGENT: <br /> ADDRESS: i��S Low S f D L_ ADDRESS: <br /> ,/n�'7 53 --f 3 <br /> PHONE: 46,6 S $$ PHONE: <br /> EMAIL: 44 r'C_( '{'d.S,/tu EMAIL: <br /> 2. DESCRIPTION OF PROJECT: (t-&J kj c .f�- if r 5)q�t NO ; <br /> ESTIMATED COST OF CONSTRUCTION: $ 1 31,603.*1 J (Strut cture plus mechanicals.) <br /> 3. ADDRESS OF PROJECT,IF KNOWN: � 31 'yam{�a t 1 ' V* to nu (.131- <br /> 4. TAX PARCEL NUMBER(as listed in AccessDane or on tax bill: i S t —• — ,9 <br /> 5 LOCATION OF PROJECT: 100a11 ItA fik.6Yd O <br /> TOWNSHIP,SECTION,1/41/4 S t(�'�'\O Y"\ 3 l )\JLkL. �j Vc,,c.i, p .+ <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: <br /> LOT NUMBER,IF ANY: L_7k A ('�� <br /> 6. ZONING DISTRICT: <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 publ c sewer,the location and size of the on-site <br /> septic system and the location of the well shall be shown on the plan.Site plan must be signed and dated <br /> Example of a site plan on back side of'his form. <br /> Your permit may require a location survey if you are within 10'of a required setback <br /> 8. FLOOR PLANS AND ELEVATION VIEWS(front,*1 copy of floor plans will be kept in the Zoning Department files. <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? �t\ t{'tom <br /> STATE SANITARY PERMIT NEEDED? Y /'� IF YES,PERMIT# <br /> APPROVAL NEEDED FOR ADDING BEDROOM OR'25%AREA? Y / N IF YES,PROVIDED? Y / N <br /> (approval letter from Dane County Environmental Health-608.242.6515) <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED. Y /( IF YES,PROVIDED? Y / N <br /> Contact County Highway Department for County Highway ccess Permits(608)266-4261. <br /> Contact DOT for access permits on State and Federal Hig ays(608)246-3800. <br /> *Towns requiring Driveway Permits are:Albion,Berry,Blooming Groove,Blue Mounds,Burke,Cottage Grove,Deerfield,Dunkirk, <br /> Dunn,Mazomanie,Montrose,Oregon,Perry,Pleasant Springs,Primrose,Roxbury,Rutland,Springdale,Springfield,Sun Prairie. <br /> 11. SHORELAND? Y/O FLOODPLAI1 ? Y WETLANDS? Y .(N'� <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) 0 <br /> *If disturbed area is greater than 4000 square feet,or is locc}ted near a lake,pond,river or stream you may need an erosion control <br /> permit. Please contact Land Conservation at(608)224-3730. <br />