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V <br /> qi <br /> DANE COUNTY ZONING DIVISION • <br /> CITY COUNTY BUILDING, RM 116 r � , <br /> 210 MARTIN LUTHER KING, JR. BLVD. <br /> • <br /> MADISON, WISCONSIN 53703-3342 <br /> PHONE 266-4266 FAX 267-1540 <br /> wWW.countvofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: V D Pr!J `• • P L(- C AGENT: <br /> ADDRESS: I . 6 ti..,ej I IA - ADDRESS: <br /> V- 11 3 <br /> PHONE: _I 1 s•,-— PHONE: <br /> EMAIL: ( rccw <br /> EMAIL: <br /> 2. TYPE OF PROJECT: 1'JQA - �-1 l i d F. <br /> ESTIMATED COST OF CONSTRUCTION: <br /> $ I(e,t) , t7 h (Structure p/us mechanicals) <br /> aJ <br /> 3. ADDRESS OF PROJECT, IF KNOWN: I }��1\iI �I r / �r ►� <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 <br /> TAX PARCEL NUMBER O 7 Q 1� <br /> SUBDIVISION OR C5M#(Certified Survey Mop),IF ANY S rr(1 C- 0 I <br /> LOT NUMBER,IF ANY: <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 al/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 on 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 Elevations attached <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? ?\. o 1 C— <br /> STATE SANITARY PERMIT NEEDED? N IF YES. PERMIT# , 5 :)-(-)3L-1 7 <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y/'A') IF YES, PROVIDED? Y <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED t Y IF YES, PROVIDED? Y/€ <br /> Many Towns require a Driveway Permit;County Highway Department or WDOT permits maybe required for <br /> driveways with access to a County,State or US Highway <br /> 11. SHORELAND? Y/ FLOODPLAIN? Y \v WETLANDS Y/0 <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) \�/ <br />