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DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING, RM 116 V <br /> 210 MARTIN LUTHER KING, JR. BLVD. <br /> MADISON, WISCONSIN 53703-3342 4 <br /> PHONE 266-4266 FAX 267-1540 4COS' <br /> www.countyofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: )J/4t' t�U�r�r/tI7 AGENT:/— <br /> ADDRESS: '733/ 1416 49LLC,' et) ADDRESS: <br /> IYf t/bLg111■ (fit 5-3.5—(9 2- <br /> PHONE: (Iota)5-(33 4/S7z) PHONE: <br /> EMAIL: G3cA)CtlARre .nfJT EMAIL: <br /> 2. TYPE OF PROJECT: 5-c/ZEEN ihRc1+ Ahbfri J /p;X/(o <br /> ESTIMATED COST OF CONSTRUCTION: $ X c0•t° (Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: `733i 01E4)11.) i/rtLLFy Rb, ohm J_hJ <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 <br /> TAX PARCEL NUMBER 07080 23'-50 <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: / /i$PE.CM//, GJ 1A1 iZS <br /> LOT NUMBER,IF ANY L"-r * 33 <br /> 6. ZONING DISTRICT: — l <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 an reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy will be kept in Zoning Division fires, <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? FRIUYrTE. <br /> STATE SANITARY PERMIT NEEDED? Y/6) IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y/© IF YES, PROVIDED? Y/ N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y/(J 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/N FLOODPLAIN? Y/6J WETLANDS Y/63 <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) N/4 <br />