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• <br /> • <br /> • <br /> DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING, RM 116 }° !�: <br /> 210 MARTIN LUTHER KING,JR. BLVD. <br /> MADISON,WISCONSIN 53703-3342 <br /> WOW 266-4266 FAX 267-1840 f E i <br /> www.countvofdane.com/zoning <br /> PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: V fgt.'C I Ctt4 s'S AGENT: <br /> ADDRESS: _bfg)I SreLs I Tnu,1W E Denvg ADDRESS: <br /> luttt otsb.4 iJ I 53 113 <br /> PHONE: 605 tC PHONE: <br /> EMAIL: <br /> 2. TYPE OF PROJECT: (`I F\.i 't-O ISIS c-T1 r <br /> ESTIMATED COST OF CONSTRUCTION: 1 V b�J (Structtow plus mechanicals.) <br /> 3. ADDRESS OF PROJECT,IF KNOWN: u <br /> 4. LOCATION OF PROJECT: �A' <br /> TOWNSHIP,SECTION 1/41/4 I W tJ OF W 1 A.1 b%ple.„,r <br /> TAX PARCEL NUMBER 1 9 1 O 9 <br /> SUBDIVISION OR CSM 0(Certifm ry <br /> d SnrnMop),IF ANY k O L a t 'a, d <br /> LOT NUMBER,IF ANY: <br /> 6. ZONING DISTRICT: W t■IDt'S12 • <br /> 7. SITE PLAN: ''A site p%on must be drown to scale showing the lot lines and lot dimensions, the location, <br /> and size of all existing and proposed bui/dings 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 as reverss. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy wail/be kept in Zoning Division files: <br /> Exa»npks of Naar Places and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC + ? <br /> STATE SANITARY PERMIT NEEDED* N IF YES. PERMIT# 57?)'9je, <br /> APPROVAL FOR ADDING BEDROOM • > 25%AREA NEEDED? Y/N IF YES, PROVIDED? Y <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT N IF YES. PROVIDED? Y/N <br /> Many Townes require a Drivency Permit;County Highway Deportment or WDOT permits may be required for <br /> driveways with access too County,State or US Highway <br /> 11. SHORELAND? Y N / FLOODPLAIN? !N WETLANDS 1 /N? <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) <br />