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kt <br /> DAN "OUNTY ZONING DIVISION ' <br /> , <br /> CITY COUNTY BUILDING, RM -116 f fl` <br /> 210 MARTIN LUTHER KING, JR. BLVD. .._ <br /> MADISON, WISCONSIN 53703-3342 <br /> • <br /> PHONE 266-4266 FAX 267-1540 sue; 7 <br /> www.countvofdane.com/zoning <br /> 0 <br /> ZONING PERMIT CHECKLIST a 2/7< <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. f <br /> I. LANDOWNER: ve J]i I, fl✓N e 2 ,I I C AGENT: <br /> ADDRESS: $O I ;5 U)l--Than.Q..IJI2. ADDRESS: <br /> PHONE: IOC R-- Q (o - 19 I PHONE: <br /> EMAIL: F N;L @ f ay(-yxnes C°EMAIL: <br /> 2. TYPE OF PROJECT: 1\/12W <br /> ESTIMATED COST OF CONSTRUCTION: $ (Structure p/us mechanicals) <br /> • <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 3 (4. ( <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 Ai °?--6?-4"4 <br /> TAX PARCEL NUMBER <br /> SUBDIVISION OR CSM#(Certified Survey Mop),IF ANY S�i2(i(- irz <br /> LOT NUMBER,IF ANY: <br /> 6. ZONING DISTRICT: <br /> 7. SITE PLAN: *A site plan must be drawn to scale showing the lot lines and lot dimensions, the location <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 /> 8 FLOOR PLANS AND ELEVATION VIEWS (front, sides, rear): A copy will be kept in Zoning Division fiks <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> STATE SANITARY PERMIT NEEDED? Y/N IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y / N IF YES, PROVIDED? Y/N <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y/ N 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) <br />