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I DANE COUNTY ZONING DIVISION »,p <br /> CITY COUNTY BUILDING, RM 116 VO P, <br /> 210 MARTIN LUTHER KING, JR. BLVD. "° ` 4 <br /> MADISON, WISCONSIN 53703-3342 ° pr.�� <br /> PHONE 266-4266 FAX 267-1540 ?SC0,16,- <br /> www.countvofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: J QN've S d1-IPart I o � AGENT: <br /> ADDRESS: `I Hawk TrLi� ) 11 ADDRESS: <br /> [ t Forec± �IA); . 5353' <br /> PHONE: g LI tD- 'a O a. PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: 'PO R- S ka d J L AV ati-OLGIAcci etv c <br /> ESTIMATED COST OF CONSTRUCTION: $ 1i S.coo (Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: ok-ci / HA IA-I T eA1 C <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 a^-'i.4D5O2 <br /> TAX PARCEL NUMBER 09ID-Des - l3BSo 0 <br /> SUBDIVISION OR CSM#(Certified Survey Mop),IF ANY:: <br /> LOT NUMBER,IF ANY:: <br /> 6. ZONING DISTRICT: t"1 _ .L Ex <br /> 7. SITE PLAN: *A site p/an 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 P/an on.reverse. <br /> 8 FLOOR PLANS AND ELEVATION VIEWS(front, sides, rear): A copy will be kept in Zoning Division files L <br /> Examples of Floor Plans and Elevations attached. 5 C <br /> 2�1�"X51 L5e-xic, <br /> 9. PUBLIC SEWER OR IVATE SEPTIC SYSTEM? <br /> STATE SANITARY PER D? Y/N IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25%AREA NEEDED? Y t.l IF YES, PROVIDED? Y/ N <br /> 10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED? Y[) IF YES, PROVIDED? Y/ N <br /> Many Towns require a Driveway Permit,.County Highway Department or WDOTpermits may be required for <br /> driveways with access to a County,State or US Highway <br /> 11. SHORELAND? Y/ N FLOODPLAIN? Y/ N WETLANDS Y N? <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) 2 '70 C) <br />