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t 1-e, f)/ S c--a � stave?). <br /> ,sue c- <br /> DANE COUNTY ZONING DIVISION O <br /> ail'COUNTY BUILDING, RM 116 t 3 l� �� 4LfL7 <br /> MADISON, WISCONSIN 53703-3342 <br /> A <br /> PHONE 266-4266 FAX 267-1540 SL's <br /> www.countvofdane.com/zoninq l '-1 `.,� ` <br /> ZONING PERMIT CHECKLIST <;cA,,,,,,51,;(k&.. &,,,1s <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. �� P <br /> _ Cr sS PI vh\s LA S35a8 <br /> 1. LANDOWNER: f►�lark Sc' ji 1e- LuAn v ' er -/Orly l<Omer° 1q5--17°0 <br /> ADDRESS: 7 7 [S H' k e JE r ADDRESS: / 7 3 Koff/1 e .)r <br /> /V1ailso►) w 1 5-37Iq 4/1 adtsrn WI 53711 <br /> PHONE: 6.08 -a-7/ - 8/57 PHONE: ea D R - 228 3 Ll O I <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: _il LL{) I40 rru- <br /> ESTIMATED COST OF CONSTRUCTION: $ c2 (p/`)J O 00 (Structure p/us mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF K N k 9'W N / e,.f _ & tl e- C/4 S Q55/ / 1 , <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 To UJn o i 6r131-o l <br /> TAX PARCEL NUMBER P t _ t� /� i <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: 4)1 n F' ! P,Id s itt Ka ll a lid Add,h ov <br /> LOT NUMBER,IF ANY: (P 8 <br /> 6. ZONING DISTRICT: <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 P/an on reverse. <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 SY TEM? P r i v a + _ - <br /> STATE SANITARY PERMIT NEEDED? iN. IF YES, PERMIT# S / 7 97 /7 <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?(F N IF YES, PROVIDED? Y /0 <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 J WETLANDS Y /D <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) 3 1 000 1 I It <br />