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• <br /> DANE COUNTY ZONING DIVISION , <br /> CITY COUNTY BUILDING. RM 116 • ,t1P" .` • <br /> 210 MARTIN LUTHER KING, JR. BLVD. \ <br /> MADISON, WISCONSIN 53703-3342 <br /> PHONE 266-4266 FAX 267-1540 (•1 " <br /> . www.countyofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: O I a - Rey Tr AGENT: <br /> ADDRESS: .EI16ati wti 4)Ib B44 S_ ADDRESS: <br /> tit rri an, t_ S35 6 I <br /> PHONE: bO$- 12111-11278 PHONE: <br /> EMAIL: T j oink @ 4A C u'1`. 4Oh1 EMAIL: <br /> 2. TYPE OF PROJECT: CC1^ar /S/or4SC Doi iC[IA UI1 ed ctlie ' <br /> ESTIMATED COST OF CONSTRUCTION: $ N.N (Structure plus mechanicds) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 7741f Ina e% RI S4Nk GTV., VIAL 53883 <br /> 4. LOCATION OF PROJECT: (� <br /> TOWNSHIP,SECTION,1/41/4 !Ok)n a4 Qe4Lofq &e.s r, -Swki Scc+oii 'V T9 N1 R7E <br /> TAX PARCEL NUMBER 0907 1 b3 -0 p Vos'3 p <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: C S N 5O k 6 <br /> LOT NUMBER,IF ANY: 10t <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 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 P/an on reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy wil/be kept in Zoning Division files. <br /> Examples of Floor Plans and Elevations attached. Q L <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? / /aC .Sebier " /%7L aid /h ftrie ' I1Gi^',' <br /> STATE SANITARY PERMIT NEEDED? Y , J IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y/ IF YES, PROVIDED? Y / N <br /> 10. DRIVEWAY(or Culvert or Access) PERMIT NEEDED? Y IF YES, PROVIDED? Y / N <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 WS Highway <br /> 11. SHORELAND? Y FLOOPLAIN? Y �(N) WETLANDS Y <br /> 12. TOTAL AREA OF LAND DISTURBANCE are!feet) v `/ <br />