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1 /S//3- <br /> DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING,PA 116 • <br /> 210 MARTIN=MR KENO,JR.BLVD. r . <br /> MADISON,WISCONSIN 53701-1342 v.�t t f' <br /> PHONE 266-4266 FAX 26T-1540 <br /> www.countvofdane.COMIZOninll <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE, <br /> 1. LANDOWNER, a!.. ! * r r1 Butt LL-L_ AGENT. • <br /> ADDRESS: # Y ♦ M4 / , /L ADDRESS: <br /> PHONE: (e 11 s. (n 00 PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROTECT: S £ "\r <br /> •. 0 • d <br /> ESTIMATED COST OF CONSTRUCTION: $ /f)(::1 �y 1 ' l (0c« (Structtie p c ca/s.) <br /> 3. ADDRESS OF PROJECT, iF KNOWN: <br /> .0 ILO V2' l crest <br /> 4. LOCATION OF PROJECT: <br /> TOWNSI{17.SECTION,1/41/4 <br /> TAX PARCEL NUMPER <br /> SUBDIVISION OR CSM#(Certified eisy lap),IF AN , <br /> LOTNUMBE(IF ANY: <br /> �.�I �v( <br /> 6. Z N&-QIST r— --- . <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 aN existing aim'proposed buildings or additions and their distances from <br /> lot lines If the lot is not served by public sourer, the location and size of Me on-site <br /> septic system and Me location of the well shall be shown on the plan. <br /> Exanpk of a Site Man on nerwrse. <br /> S FLOOR PLANS AND ELEVATION VIEWS(front, sides,rear): A copy will be kept In Zonirg Division files. <br /> Examples of Floor Plans and Ehe►wttcnr attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? Put19- c� <br /> STATE SANITARY PERMIT NEEDED? CP/N IF YES. PERMIT# 1 3—act 4•-ff)(3 / <br /> APPROVAL FOR ADDING BEDROOM OR ' 25%AREA NEEDED? Y/ IF YES, PROVIDED? Y <br /> 10. DRIVEWAY(cc Culvert or Access)PERMIT NEEDED? Y 01 IF.YES, PROVIDED? Y <br /> Many Towns rewire a Driwerlrry Piermit,•County H/ghs ayDepartment or WDOTpermits maybe required for <br /> driveways with access to a County,State or US Highway <br /> • <br /> 11. SHOREL{ND? Y IF N J FLOODPLAIN? Y WETLANDS Y/ ?1 <br /> 12. TOTAL AREA OP LAND DISTURBANCE(Square feet) <br />