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i/ 15'- <br /> •DANE COUNTY ZONING DIVISION • <br /> GTry COUNTY BUILDING,WA 116 37-Vt. <br /> . ro <br /> 210 MARTIN LUTHER KING.J0.BLVD. <br /> MADISON.WISCONSIN 53703.3342 of.6"e <br /> PHONE 266-4266 FAX 267-1540 ,y . . <br /> www.courltvofdane.com/zonlnq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE., <br /> 1. LANDOWNER: of i ` f! L L1 L-(— AGENT: <br /> ADDRESS: Y 0 161 ; G. Q !L ADDRESS: <br /> ! � <br /> PHONE: (I/4 • PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: v .... 0 <br /> ESTIMATED COST OF CONSTRUCTION: $ G k 0 00 (Structwie plus mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: <br /> 4. LOCATION OF PROJECT: ,, • <br /> TOWNSHIP,SECTION,,1/41/9 a ` "-ii <br /> TAX PARCEL NUMBER <br /> 51/BOIVISIONORCSM#(Cerfified Survey Map),1FANY: G VUC'Q i` 1 t <br /> LOTMUMBER.TF ANY: / 0 3 <br /> 6--Z-aPFIN6-DISTRECT. <br /> 7. SITE PLAN: "4 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 /> Exaap/c of a Site Plan on revere. <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 Venation,attached.`che <br /> 9. PUBLIC SEINER OR PRIVATE SEPTIC SYSTEM? { t <br /> STATE SANITARY PERMIT NEEDED? p/N IF YES, PERMIT# / g-10/4 —.00p?0 '7 <br /> APPROVAL FOR ADDING BEDROOM OR a 23%AREA NEEDED? Y/ Ip IF YES, PROVIDED? Y <br /> 10. DRIVEWAY(or Culvert or Axes)PERMIT NEEDED? Y `N IF.YES, PROVIDED? Y 4) <br /> Many Towns require a Driveway Permit;County/ ghney Department or WDOT permits maybe required for <br /> driveways with access.to a County,State or US Highway <br /> • <br /> 11. SHORaAND? Y/F N 1 FLOODPLAIN? Y (N) WETLANDS Y/ <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) <br />