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• <br /> q iS/,S <br /> DANE COUNTY ZONING DIVISION "e �'► <br /> CITY COUNTY BUAbr,o. RM 116 �'• '° <br /> 230 MARTIN UJTHER ICING,JR. BLVD. • <br /> MADISON.WISCON5IN 53703-3342 <br /> • <br /> PHONE 266-4266 FAX 267-7540 <br /> vwvw.courtYoidane.comlzaninq <br /> ZONING PERMIT CHECKLIST <br /> • <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER; / ' I ` an 1 ti , AGENT: • <br /> ADDRESS: . Y O e1�.LL 1. a ADDRESS: <br /> Ct. I ` • <br /> PHONE: (i ��i� (n "-- )100 PHONE: <br /> EMAIL: C C EMAIL: <br /> 5 2. TYPE OF PROJECT: V (.0 I . • B <br /> ESTIMATED COST OF CONSTRUCTION: t �O c7t3 (Structuie plus merhanica/s) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: <br /> 4. LOCATION OF PROJECT: ,� I fik <br /> TOWNSHIP,SEC7TON,1/4 L4 a ' r► •t� <br /> TAX PARCEL NUMBER '1� <br /> 51/BD.TPISIONOR CSM#(Certified 5wwr ap) ANf C U.c- 14 <br /> LOT MOOR IFANY: <br /> 7. SITE PLAN: `A site plan must be drown to scale showing the lot lines and lot dimensions,the locotioi <br /> and size of all existing and pvioposed 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 /> _ Exsonpk of a Site Man on remrre. <br /> B FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy will be kept in Zoning Division files. <br /> &ample:of Floor Plans and Ekvalions attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> STATE SANITARY PERMIT NEEDED? N IF YES. PERMIT# (n 3 <br /> APPROVAL FOR ADDING BEDROOM OR a 25%AREA NEEDED? Y/e IF YES, PROVIDED? Y N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y IF YES, PROVIDED? Y/N <br /> Many Towns require a Driveway Permit,'County Highway Department or WDOTpermits may be required for <br /> driveways with accessss to a County,State or VS Highway <br /> 11. SHORELIND? Y I(N J FLOODPLAINT Y (N ) WETLANDS Y/�Cr/, <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) •� <br />