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DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUII.IING, RM 116 - 001 b <br /> / {Q� f0 <br /> 210 MARTIN LUTHER KING, JR. BLVD /vv QBV a s <br /> MADISON, WISCONSIN 53703-3342 �il <br /> PHONE 266-4266 FAX 267-1540 <br /> www.counryofdane.com/zoninq <br /> %4A �' 41-t1ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> r> nLC/11 oI <br /> 1. LANDOWNER: ✓0'7 5 Lob/'L! MCIn Orl ` w. AGENT: r••.'■`'• iI' Jc cq^�.')U el O, <br /> ADDRESS: Sly` {6iafa.5e Gori(�/ ADDRESS: `Q8II cwt., Avt%'1(/f, <br /> CU I 35-9 /hid//' i mn wi 3-3510V <br /> PHONE: , ► , V i. -/ A PHONE: (1008) 121 W j <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: Raclin, c NIA ) n'/ /'f,ci..ho/nt ; ail /7247 /L,„4,/" Jr`C- <br /> ESTIMATED COST OF CONSTRUCTION: $ 10 7✓ P O Q (Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 5-99 134/L7t y -01 'kW" <br /> Dc s Mobile" /f4n or IA/41mA lie e v0 <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SEC7ION,1/41/4 fGI-t") °+ S!'r'#Gl-1 54-1-:on .2 <br /> TAX PARCEL NUM o <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY:: <br /> LOT NUMBER,IF ANY.- j -1(o <br /> 6. ZONING DISTRICT: NO s C )Ur%I-1 2-0nitit) )rr, 1Q/d <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 Nellsha//be shown on the plan. <br /> Example of a Site P/m► anreverse. <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? Smarts ' (.0)--e Kr) <br /> STATE SANITARY PERMIT NEEDED? V /O IF YES, PERMIT it <br /> APPROVAL FOR ADDING BEDROOM OR s 25% AREA NEEDED? Y/ N IF YES, PROVIDED? Y/ N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y/pN IF YES, PROVIDED? Y/ N <br /> Many Towns require a Driveway Permit-County Highway Deportment or WDOT pertnits may be required for <br /> driveways with access to a County,State or US Highway <br /> 11. SHORELAND? Y 6 FLOODPLAIN? Y AID WETLANDS Y ,G) <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) (. 705G/c}- <br />