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DANE COUNTY ZONING DIVISION gd° <br /> CITY COUNTY BUILDING, RM 116 ift.)O L \!y <br /> 210 MARTIN LUTHER KING, TR. BLVD. £ <br /> MADISON, WISCONSIN 53703-3342 <br /> PHONE 266-4266 FAX 267-1540 ?SCOTZS_" <br /> wwW.countvofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> U- R ixtfL S k c <br /> 1. LANDOWNER: / AGENT: <br /> ADDRESS: '6 (1 /1/19 Q M A N U'A-y ADDRESS: _ <br /> MA D SDN _%,V( 5.3705 <br /> PHONE: 6C I, 335. ti r"r PHONE: <br /> U T <br /> EMAIL: M( OMES @rale.(Oggn; <br /> 2. TYPE OF PROJECT: /V e W `-�' ( l�6,44"�` g <br /> ESTIMATED COST OF CONSTRUCTION: $ 2 7c, 000 (Structure p/us mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 69-f- 6 (3 16) e - e r` kfl( <br /> RO 14- urc S3 s9 <br /> 4. LOCATION OF PROJECT: r <br /> TOWNSHIP,SECTION,1/41/4 To IA/A/ Or N V L 7 v� �C t/ /V 3 Z. <br /> TAX PARCEL NUMBER (93 2 /0?-0,8 -3 2 Z —2 OS6 -o <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: 6 2 6- c.+e" Z/k <br /> LOT NUMBER,IF ANY: <br /> ‘ - - (6. ZONING DISTRICT: <br /> 7. SITE PLAN: *A site plan must be drawn to scale showing the lot lines and lot dimensions, the locatior, <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? l U / ( <br /> STATE SANITARY PERMIT NEEDED? I Y y N IF YES, PERMIT# /V C <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y / N IF YES, PROVIDED? Y/ N <br /> 10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED?I Y p N IF YES, PROVIDED? l�N <br /> Many Towns require a Driveway Permit;County Highway Department or WDOT permits may be required for <br /> driveways with access to a County, State or US Highway <br /> 11. SHORELAND? Y/ N FLOODPLAIN? Y / N WETLANDS Y/ N? <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) 5,000 <br />