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DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDIKT6, am 116 <br /> I <br /> 210 MARTIN LUTHER KING, JR. BLVD. +��b # ' <br /> - i <br /> MADISON, WISCONSIN 53703-3342 h ? y <br /> PHONE 266-4266 FAX 267-1540 ,`,; C(3235.., <br /> www.cou ntyofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: S01•1 r RAW 1-/,u6 AGENT: `6 i*err/ CO4/5%,/ LLCM <br /> ADDRESS: 1(0/3 ShA-dv41 C 0(,c, Tic ADDRESS: /o3 6 /f, //C..g.6S'T– tit) <br /> ffll'QOlemii, WJ S356) O' 6bcf", w 5-351S— <br /> PHONE: C6O08)a0 3-6/6 7 PHONE: (60f) 8_35• ? goy <br /> EMAIL: EMAIL: <br /> • <br /> 2. TYPE OF PROJECT: /U LIJ /i i 1 i 0.0 A/5/PI d- O " <br /> 76/c� � o <br /> ESTIMATED COST OF CONSTRUCTION: $ 6 , %/g. — (Structure p/us mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: L0 a g re Av c(Am go, 32-53 3 "efi o t"`g" e_ <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 �GV c� Q� i Q 0/f�/l/ _ <br /> TAX PARCEL NUMBER 010 C, —323-- 4l 6 S -- <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: G C54-'S AI D <br /> LOT NUMBER,IF ANY. c)8 <br /> 6. ZONING DISTRICT: 1 �%S f EN T l /1- L- <br /> 7. 51 i t PLAN: 'A site plan must be drawn to scale showing the lot lines and lot dimensions, the/ocatior, <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 /> B 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? P2 ' tJ' r`- <br /> STATE SANITARY PERMIT NEEDED? (/ N IF YES, PERMIT# _57 S 0 F (O <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y /se IF YES, PROVIDED? Y / N <br /> 10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED? ©/ N IF YES, PROVIDED? Y /6 <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 /J FLOODPLAIN? Y /� WETLANDS Y / 1? <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) ,x10/ C D 5✓` Fl <br />