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• <br /> DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING,RM 116 <br /> • 210 MARTIN LUTHER KING,JR.BLVD. <br /> MADISON,WISCONSIN 53703-3342 `� " i `'�, <br /> PHONE 266-4266 FAX 267-1540 v 'c = l'D <br /> www.co.dane.wi.us 4.4 4 <br /> )839_j <br /> ZONING PERMIT CHECKLIST `'' ,pc, 1' f <br /> 1. LANDOWNER: /0 J AGENT: <br /> ADDRESS: f A 0 ADDRESS: <br /> PHONE: 0 ' — ' i PHONE: <br /> EMAIL: NA / EMAIL: <br /> 2. DESCRIPTION OF PROJECT: O r'C f) <br /> ESTIMATED COST OF CONSTRUCTION: $ ■1 060 (Structure plus mechanicals.) <br /> 3. ADDRESS OF PROJECT,IF KNOWN: ,W (�y70 / ' % /J 13 j <br /> 4. TAX PARCEL NUMBER(as listed in AccessDane or on tax bill: Of,—0 /(—p ��— '''y c) 3 <br /> 5 LOCATION OF PROJECT: 30 LO/ UI7 C1 (K<1j DP_P, l el(,/ <br /> TOWNSHIP,SECTION,1/4 1/4 CO/ a 'e, Gr'OYP <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: <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.Site plan must be signed and dated. <br /> Example of a site plan on back side of this form. <br /> 8. FLOOR PLANS AND ELEVATION VIEWS(front,*1 copy offloor plans will be kept in the Zoning Department files. <br /> Examples of Floor Plans and Elevations attached <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? <br /> erivd <br /> f(� <br /> STATE SANITARY PERMIT NEEDED? Y () IF YES,PERMIT# <br /> APPROVAL NEEDED FOR ADDING BEDROOM OR>25%AREA? Y /9 IF YES,PROVIDED? Y / N <br /> (approval letter from Dane County Environmental Health-608.242.6515) <br /> 10. DRIVEWAY(or Culvert or Access)PERMIT NEEDED? Y 'CD IF YES,PROVIDED? Y / N <br /> Contact County Highway Department for County Highway Access Permits(608)266-4261. <br /> Contact DOT for access permits on State and Federal Highways(608)246-3800. <br /> *Towns requiring Driveway Permits are:Albion,Berry, Blooming Groove,Blue Mounds,Burke, Cottage Grove,Deerfield,Dunkirk, <br /> Dunn,Mazomanie,Montrose,Oregon,Perry,Pleasant Springs,Primrose,Roxbury,Rutland,Springdale,Springfield,Sun Prairie. <br /> 11. SHORELAND? Y' J FLOODPLAIN? Y /�I WETLANDS? Y ' <br /> 12. TOTAL AREA OF LAND DISTURBANCE(Square feet) ago <br /> *If disturbed area is greater than 4000 square feet,or is located near a lake,pond,river or stream you may need an erosion control <br /> permit. Please contact Land Conservation at(608)224-3730. <br />