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.y' <br /> • <br /> /icy <br /> DANE COUNTY ZONING DIVISION 4' 4, <br /> crr/COUNTY BUILDING, RA 116 • ` ' <br /> 210 MARTIN LUTHER IEN&,JR.BLVD, • <br /> MADISON.WISCONSIN 53703-3342 , <br /> PHONE 266-4266 PAX 267-1540 <br /> www countvofdane.comhoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE <br /> 1. LANDOWNER; V f. fl ei LL-L AGENT: <br /> ADDRESS: t + R 01 Al t.OL ADDRESS: <br /> MCLICIEN11 Al S f`3 <br /> PHONE: (j)el 8 f,n " i/00 PHONE: <br /> EMAIL: F!(-gi er r Ex.to VOC' r.111riJjCMEMM+IAIL: <br /> 2. TYPE OF PROJECT: c -. � �o ` 4'41 ESTIMATED COST OF CONSTRUCTION: $ .? �/1 (Structu a plus mec ak) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: <br /> exe OD VJ ( 7J <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/4 1/4 -TO\,010 x l T-.M <br /> TAX PARCEL NUMBER <br /> S V/B D I V I S I O W OR C S M#(Certified S u r v e y M a p},IFAA0 - F .s` <br /> LOT-NUMBER IF ANY; `/ 0�1 <br /> 6. - ONING ----- �}—'— ��� -- — <br /> 7. SITE PLAN: *A site plan must be drawn to scale showing the lot lines and lot dbnensions,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 sits <br /> septic system and the location of the mail shot be shown on the plan <br /> Eragale of a Site Parr on rwi.vr e. <br /> $ FLOOR PLANS AND ELEVATION VIEWS(front, sides,rear): A copy will be kept in Zonlgq Division f/ks. <br /> Examples of Floor Plans and Ekwstions attached, <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> STATE SANITARY PERMIT NEEDED? /N IF YES, PERMIT 791 ,1415111:100 <br /> APPROVAL FOR ADDING BEDROOM OR s 257E AREA NEEDED? Y/ IF YES, PROVIDED? Y CN) <br /> 10. DRIVEWAY(er Culvert or Access)PERMIT NEEDED? Y IF.YES, PROVIDED? Y/ T,,) <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 1/S Hlyhw+ay <br /> 11. SHORELAND?- Y/i N 1 FLOODPLAIN? Y,(N J WETLANDS Y/ <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) <br />