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DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING, RM 116 V�, L 'b <br /> 210 MARTIN LUTHER KING, JR. BLVD. <br /> MADISON, WISCONSIN 53703-3342 p? <br /> PHONE 266-4266 FAX 267-1540 `pCs <br /> www.countvofdane.com/zoninq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> masse 51--W <br /> 1. LANDOWNER: t fj.,JC VJc\( ' \�cs:x\� 52��la- AGENT: `TG t)e.i itxlea, <br /> ADDRESS: Y. ) 1/,P11►her Ri 128ci. ADDRESS: yO iQ . WI.in I?C\, <br /> O.\ NpcPlro U)\ f 1 ?lue Mcuv•cis 7 <br /> PHONE: (poB' " Le7-4877 PHONE: ( O6• b\81 <br /> EMAIL: ,O 4 I c(VJ C Mac-C4 EMAIL: 1`rllC11Q"-\1eOD OptVf:v ti•C CST-■ <br /> btiGLLe4 <br /> 2. TYPE OF PROJECT: ac j C x; 'r-t I Ur_k"(C:t l d r x 3 ' <br /> ESTIMATED COST OF CONSTRUCTION: $a=2,CCU Cr.) (Structure plus mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: c I <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 01 -9 S\)3 <br /> TAX PARCEL NUMBER 0(L(3 1 G Tn(r— -• (j Ca L16-✓I <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: <br /> LOT NUMBER,IF ANY: CACL <br /> 6. ZONING DISTRICT 1" <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 SYSTEM? Pr 1 JCX te. <br /> STATE SANITARY PERMIT NEEDED? Y "U IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y /E 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 maybe required for <br /> driveways with access to a County, State or US Highway <br /> 11. SHORELAND? N FLOODPLAIN? Y CN WETLANDS Y/P <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) I,1e0 c-y;\ <br />