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iI <br /> is <br /> DANE COUNTY ZONING DIVISION <br /> CITY COUNTY Bk.n:Lu G,M 116 <br /> 230 MARTIN LUTHER W45,JR.BLVD. '' R'- <br /> MADISON.WISCONSIN!37Q3-3341 • If: Ch. <br /> PHONE 266-4266 FAX 2671540 <br /> vrww.imuntvofdane.comzonina <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE, <br /> �l {y [,may, <br /> 1. LANDOWNER: tf f'. t`x f1 _Jw{I�i6 61-Lk- A6EM <br /> ADDRESS: )O J,( !0.14pit. I4- ADDRESS: <br /> Ma_ i" t a r t <br /> PHONE: (i) Ci ) PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: V ■. i 0 t' <br /> ESTIMATED COST OF CONSTRUCTION: .� A 0 (Strucftre plusmechonicals:) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: Ot-e-aZYWA. POI;1‘2116-41' <br /> 4. LOCATION OF PROJECT: <br /> TVWN N,SXaP,SECTION 1/9 s t, t 14u i5 <br /> TAX PARCEL NUMBER <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY C <br /> LOT NUMBER,IF ANY: 3 3 <br /> b—�ONFN6- --- - - zt�4--- --• ---- <br /> 7. SITE PLAN: 'A site plan must be.drawn to scale showing the lot lints 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 /> Exanpk of a Site Plan on reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(f r o n t,sides,rear): A copy w/1/be kept in Zoniy Division fiks <br /> Examples of Floor Plans and Ekerotibns attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? PLA-1..•-tg-4-- <br /> STATE SANITARY PERMIT NEEDED? /N IF YES. PERMIT if 13 -a 0 i lD-Cr) <br /> APPROVAL FOR ADDING BEDROOM OR a 25%AREA NEEDED? Y/ IF YES. PROVIDED? Y N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y 04 IF.YES, PROVIDED? Y/(14-J.,) <br /> Many Towns require a DriveneyPermit;County HighweayDepartment or WDOT permits maybe required for <br /> drireewnys with access to a County,State or USHighwesy <br /> 31. SHOR ®�ELAND? Y d N 1 FLOODPLAIN? Y�(td J WETS Y/ <br /> 12. TOTAL AREA OP LAND DISTURBANCE(Square feet) <br />