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1 <br /> DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING,RM 116 ii■■ .:-ir%:' <br /> 210 MARTIN LUTHER KING,JR. BLVD. a `- "'' <br /> MADISON. WISCONSIN 53703-3342 " ` <br /> PHONE 266-4266 FAX 267-1540 BCOS <br /> www.countyofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: J e'r0 604. Anh� Mosey' AGENT: <br /> AGENT: <br /> ADDRESS: t t4 CAUL► KOo-i T ADDRESS: <br /> \itYttilka INT-15-39)3-9'0 SC- <br /> PHONE: 4,0$ -c 4 S--14 c Py: <br /> - <br /> EMAIL: Jev�r`si YMOSSeY`G. &S.na EMAIL: 11 <br /> 2. TYPE OF PROJECT: Kr e VJO•i S f e, c ha d $'X NCO r l y i• <br /> 41 it <br /> ESTIMATED COST OF CONSTRUCTION: $ 1 0 n 0 t Cl. (Structure pl. mechanica <br /> ,s 3. ADDRESS OF PROJECT, IF KNOWN: S A �� S 4.,10 bV.� <br /> 4. LOCATION OF PROJECT: (.1 V <br /> TOWN(S/fP,SECTION,1/41/4 Sp"`i J (2 J Se c�� 0 N 2 <br /> TAX PARCEL.NUMBER c954-043ol_... b2(- c Z-5`= 7 &AAA 0SA---0031-oZI-ly7 ^Z <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY.' 47-6-`° <br /> LOT NUMBER,IF ANY <br /> 6. ZONING DISTRICT: A - V <br /> 7. 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 SY Np4 11 - <br /> STATE SANITARY PERMIT NEEDED? Y IF YES, PERM �# <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y 0 IF YES, PROVIDED? Y/N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y{[N 1 IF YES, PROVIDED? Y /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 rip FLOODPLAIN? Y'�.J pWETLANDS Y/if) <br /> 4. <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) l 12 0 S ..A.-. W 1"l y0-o <br /> twArikiftmt) <br />