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DANE COUNTY ZONING DIVISION <br />CITY COUNTY BUILDING, RM 116 <br />210 MARTIN LUTHER KING, JR. BLVD. <br />MADISON, WISCONSIN 53703-3342 iaa <br />PHONE 266-4266 FAX 267-1540 `S OKE <br />www.cDuntvofdane.com/zoninq <br />ZONING PERMIT CHECKLIST <br />PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE <br />LANDOWNER: la 701 PI Md MUG-, LLC- AGENT: <br />ADDRESS: 15o(w 6 wAii-lioc ri2j /%Oe ADDRESS <br />jjAD15y0 , W 6 -1 -704 - <br />PHONE: <br />EMAIL: <br />PHONE: <br />EMAIL: <br />AL Co K7Srwcrt0J A oe6iCv�-A <br />2. TYPE OF PROJECT: ►l eto Cc)L,C x I D j (LEP s <br />ESTIMATED COST OF CONSTRUCTION: 61-706C)6 (Structure plus mechanicals.) <br />3. ADDRESS OF PROJECT, IF KNOWN: U j3Ei,rL,A.('e- 44wv, n10k 11F #1AD "h70`4 <br />4. LOCATION OF PROJECT: <br />TOWNSHIP SECTION, 1/41/4 <br />TAX PARCEL NUMBER O jag `6 (0I 9 090 <br />SUBDIVISION OR CSM # (Certified Survey Map), IF ANY.C6 M <br />LOT NUMBER, IF ANY: (.0 -1— <br />—276. ZONING DISTRICT: G-2- <br />7. <br />. 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 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? &e'L-1C/ <br />STATE SANITARY PERMIT NEEDED? Y /l/ IF YES, PERMIT # <br />APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y / N IF YES, PROVIDED? Y / N <br />4o".- <br />10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED? Y 49 IF YES, PROVIDED? Y / N <br />Many Towns require a Driveway Permit, County Highway Department or WDOTpermits may be required for <br />driveways with access to a County, State or US Highway <br />11. SHORELAND? Y ON FLOODPLAIN? Y WETLANDS Y / N? <br />12. TOTAL AREA OF LAND DISTURBANCE (Square feet) <br />