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• J <br /> • <br /> • <br /> PANE COUNTY ZONING DIVISION <br /> CM COUNTY WILDING, RN 116 <br /> 210 MARTIN LUTHER KING, JR. BLVD. <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 PASSIBLE. <br /> • <br /> 1. LANDOWNER: V gtd C I CA) UP k Es AGENT': <br /> • <br /> ADDRESS: Ike 1 Snu.•rUa TDu.1IN a DRAM ADDRESS: <br /> lutes m sewks 14 1 53 113 <br /> PHONE: (acV15 • 22rs. 3f tNes PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: (iF.k J l O ISIS 1J <br /> ESTIMATED COST OF CONSTRUCTION: $ ` 4/0 000_ 00 (Structu a plus mechanicals.) <br /> 3. ADDRESS OF PROJECT,IF KNOWN: /fl 92 /L) <br /> 4. LOCATION OF PROJECT: �—�-'' `.1 <br /> TOWNSHIP,SECTION,1/t 1/f I A w!J OF W <br /> TAX PARCEL NUMBS? D? I0c 10 3 I 'S lO <br /> SUBDIVISION ORCSM#(Certified��SurveyM+op),IF ANY: <br /> LOTMVMBER,If ANY: I/ <br /> 6. ZONING DISTRICT: <br /> 7. SITE PLAN: *A site pkn nut be&awrm to soak showing the lot lines and lot dimensions, the locatiar; <br /> and size of all existing and propose d buildings or additions and their distances from <br /> lot tines 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 wiel/she//be shown on the plan. <br /> Emma of a Sift Malt aaI PInsres. <br /> FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy rri//be kept in Zanily Division Nee <br /> &ample,of floor Pleas and Elerrrtrions attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? I A <br /> S T A T E S A N I T A R Y P E R M I T N E E D E D?(j N IF YES. PERMIT* . <br /> APPROVAL FOR ADDING BEDROOM OR a 25%AREA NEEDED? Y() IF YES, PROVIDED? Y/ <br /> 10. DRIVEWAY(or Culvert or Aceess)PERMIT NEEDED? Y/�1 IF YES, PROVIDED? Y `6l <br /> Many Towns require a OryvewayPermit, County Hig stly Department or WOOTpermits may be required for <br /> drivesays with access to a County,State or US Highawry <br /> I1. SHORELAND? Y/e FLOODPLAIN? Y N WETLANDS Y/ <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) <br />