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/i7'ic DANE CO <br /> UNTY ZONING DIVISION • <br /> GTTy COUNTY BUILDING, RA 116 <br /> 210 MARTIN LUTHER KING,JR. BLVD. , + ,' <br /> MADISON, WISCONSIN 53703-3342 <br /> • <br /> �t1}t <br /> PHONE 266-4266 FAX 267-1540 <br /> www.countvofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: Y ' �-�i CY ti Ci ft l+l i -L--(_ AGENT: • <br /> ADDRESS: O S O � '` i 0( fie wt._ ADDRESS: <br /> PHONE: (tr l D-ja, (n 7/00 PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: V ) (Lon f,~ . <br /> tea <br /> ESTIMATED COST OF CONSTRUCTION: 4 - . 3 a.0 W(Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: t V L-r CL <br /> 4. LOCATION OF PROJECT: _ <br /> TOWNSHIP,SECTION 1/4 1/4 1 Q `'� <br /> TAX PARCEL NUMBER <br /> 5U8DIVI5ION OR C5M#(Certified Surveyor), ANY'. G f U c`Q 140 11 1 <br /> LOT NUMBER,IF ANY l <br /> G—z�NIN6 DISTirIEF <br /> V■ J_,D <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 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 E/e►wfions attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? _ �UL <br /> STATE SANITARY PERMIT NEEDED? ®/N IF YES, PERMIT# 13 c)-( <br /> APPROVAL FOR ADDING BEDROOM OR ) 25%AREA NEEDED? Y/ J IF YES, PROVIDED? Y N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y C✓ 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 /> 11. 5HORELAND? Y N j FLOODPLAIN? Y e WETLANDS Y/ <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) <br />