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O Cv O 0I/6)3 <br /> 5c._,3 ,, ,_-- , <br /> DANE COUNTY ZONING DIVISION ( r 1.,. ..,..-.:7-.. r."7„ap. ,,,,,CI TY COUNTY 9UZLDING- RM 116 :�21D MARTIfJ LtltHER I�hIC>, TR. 6LVb. .; t- , �.„ <br /> MADISON• WI5CON5IN 53703-3342 t L'.j <br /> PHONE 266-4266 FAX 267-1540 <br /> WWw.COuntyofdane.com/zoninq 3. <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMA .ON AS POSSIBL . <br /> .1, LANDOWNER: ; i&h# L if/ AGENT: <br /> ADDRESS: /ir o : f�/«. afff. ADDRESS: <br /> ms `L,_' • •1+ 53570. <br /> PHONE: iIf .. ; e <br /> f'�' f�� PHONE: <br /> EMAIL: 1 EMAIL: <br /> 2- TYPE Of PROJECT: AI& Ar:� !," <br /> .ESTJ.MATEb COST OF CONSTRUCTION; $ (Structure plus inechanicols) <br /> 3. ADDRESS OF PROJECT. IF KNOWN: <br /> 4. LOCATION OF PROJECT: �j� �j j <br /> TOWNSf P SEC7ION,1/41/4 [ 643 /" 33 /! Cam. `- <br /> TAX PARCEL NUMBER / I - • •ii . <br /> SUBDIVISION ORC5M#(CertificdSurve Mop),IFANY-- ' �� fir"ir° - <br /> LOTNUMBER,IFANY; 1'1 r <br /> 6. ZONING DISTRICT: A! <br /> .O SITE'PLAN: *A site plan must be drag to stale showing the lot lines and lot dimensions, the location <br /> ��v// 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 /> &ampk of u Site Plan on reverse. <br /> .446%.****>< <br /> FLOOR PLANS AND ELEVATION VIEWS (front, sides, rout): A copy wil/be At inZoni,g Division files- <br /> Examples of Floor Plans and Elevations attached, <br /> PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? -_ <br /> STATE SANITARY PERMIT NEEDED? V / N IF YES, PERMIT 4—_ <br /> APPROVAL FOR ADDING BEDROOM OR > z5% AREA NEEDED? Y / N IF YES, PROVIDED? Y / N <br /> DRIVEWAY(or Culvert or Access) PERMIT NEEDED? Y / N IF YES, PROVIDED? Y / N <br /> Mony Towns require a Driveway Permit;County Highway Deportment or WbOT permits may be required for <br /> driveways with access to a County,State or US Highway <br /> • <br /> ----,_qy. sHORELAND? Y / N FLWODPLAIN? Y / N WETLANDS Y / N? <br /> 12_ TOTAL AREA OF LAND DISTURBANCE (59tnre feet) _ <br /> TO 39dd 0000000000 817:EZ 9002/8Z/ZT <br />