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DANE COUNTY ZONING PERMIT CHECKLIST
<br /> 210 Martin Luther King Jr.,Blvd.,Room 116 Madison,WI 53703(608)266-4266
<br /> 1. LANDOWNER: 6V Q eCn/eruct(;i.-,9.2 A C.4T I CL(VGF:�AGENT: -54 ,� e oft o c")`^o✓
<br /> ADDRESS: 41/?7 C t7 c.t /Z 1 ADDRESS:
<br /> vl La'c60 t.15 5371$
<br /> PHONE: 2Z PHONE: 'sri?vie as eliam -La"
<br /> EMAIL: .c• 1•6,- • , .rje --EMAIL:
<br /> 2. DESCRIPTION OF PROJECT: Rip
<br /> ESTIMATED COST OF CONSTRUCTION: $ (p)00 (Structure plus mechanicals.)
<br /> 3. ADDRESS OF PROJECT,IF KNOWN: S a v-si 0, 4 S O .-)`^ t
<br /> 4. TAX PARCEL NUMBER(as listed in AccessDane or on tax bill:
<br /> 5 LOCATION OF PROJECT:
<br /> TOWNSHIP,SECTION,1/4 1/4
<br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY:
<br /> LOT NUMBER,IF ANY:
<br /> 6. ZONING DISTRICT: 'TO K. 42 3(,o,o,,,,
<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.Site plan must be signed and dated.
<br /> Example of a site plan on back side of this 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? V 1 OA
<br /> 2
<br /> STATE SANITARY PERMIT NEEDED? ❑Ykc]N IF YES,PERMIT# tl (4
<br /> APPROVAL NEEDED FOR ADDING BEDROOM OR>25%AREA? ❑Y IF YE ,PROVIDED? ❑Y ON
<br /> (approval letter from Dane County Environmental Health-608.242.6515)
<br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? ❑YgIN IF YES,PROVIDED? ❑Y ON
<br /> Contact County Highway Department for County Highway Access Permits(608)266-4261.
<br /> Contact DOT for access permits on State and Federal Highways(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? ❑YIN FLOODPLAIN? ❑YKN WETLANDS? ❑YON
<br /> p
<br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) 2 0 c4
<br /> *If disturbed area is greater than 4000 square feet,or is located near a lake,pond,river or streap you may need an erosion control
<br /> permit. Please contact Land Conservation at(608)224-3730.
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