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DANE I I Ti'ZONING DIVISION 1 9i-
<br /> CITY C• I TY BUILDING,RM 116 O 4f x,,
<br /> 210 MARTIN LUTHER KING,JR.BLVD. � ,'°����
<br /> MADISON,WISCONSIN 53703-3342 ,-/c, ,L I t 't" s,
<br /> PHONE 266-4266 FAX 267-1540 A �q /4----1)-' 1 i °-
<br /> www.co.dane.wi.us �l ','� `-Z
<br /> �pF\ �` 1$39 il
<br /> ZONING PERMIT CHECKLIST {', .sco ,1�
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<br /> I. LANDOWNER: 4.__/2/'- �cGCJ AGENT:
<br /> ADDRESS: 15f 7 ,n C!1 ;12‘'/ ADDRESS:
<br /> 19I''e e-)/1 *-1--Z- -.C.R5>_s-
<br /> PHONE: r flt ∎ - i'I C, PHONE:
<br /> EMAIL: v1IQ,i`Ur. ,Ga EMAIL:
<br /> 2. DESCRIPTION OF PROJECT: a 6 ',Y3(:2 / Ca/`al -e--
<br /> ESTIMATED COST OF CONSTRUCTION: $ gaQQ oo (Structure plus mechanicals.)
<br /> 3. ADDRESS OF PROJECT,IF KNOWN: yel 7 C7,e3 o yl �j- i, I
<br /> 4. TAX PARCEL NUMBER(as listed in AccessDane or on tax bill:c (9 Y(2-7Q—cf2/ Y/^ ( 0/7-o
<br /> 5 LOCATION OF PROJECT: /a,rt)h Di (91`e PJ/1
<br /> TOWNSHIP,SECTION,1/4 1/4 A `' n^
<br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: J C7-4/!Sc)ri 1/'/41/4.9
<br /> LOT NUMBER,IF ANY: La 't a 7
<br /> 6. ZONING DISTRICT: /"7 v C/ Y' d/'� / rp S
<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
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<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.Site plan must be signed and dated.
<br /> Example of a site plan on back side of this form.
<br /> 8. FLOOR PLANS AND ELEVATION VIEWS(front,*I copy of floor plans will be kept in the Zoning Department files.
<br /> Examples of Floor Plans and Elevations attached c' �/
<br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? P'`,,v a y e ,Sp-1 t'C S yS I`e'M►
<br /> STATE SANITARY PERMIT NEEDED? Y () IF YES,PERMIT#
<br /> APPROVAL NEEDED FOR ADDING BEDROOM OR>25%AREA? Y 400 IF YES,PROVIDED? Y / N
<br /> (approval letter from Dane County Environmental Health-608.242.6515)
<br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y QN IF YES,PROVIDED? Y / N
<br /> Contact County Highway Department for County Highway Access Permits(608)266-4261.
<br /> Contact DOT for access permits on State and Federal Highways(608)246-3800.
<br /> *Towns requiring Driveway Permits are:Albion,Berry,Blooming Groove,Blue Mounds,Burke, Cottage Grove, Deerfield,Dunkirk,
<br /> Dunn,Mazomanie,Montrose,Oregon,Perry,Pleasant Springs,Primrose, Roxbury,Rutland,Springdale,Springfield,Sun Prairie.
<br /> 11. SHORELAND? Y 0 FLOODPLAIN? Y 6 WETLANDS? Y Of
<br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) 750 DTeX-
<br /> *If disturbed area is greater than 4000 square feet,or is located near a lake,pond,river or stream you may need an erosion control
<br /> permit. Please contact Land Conservation at(608)224-3730.
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