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DANE COUNTY ZONING DIVISION "`-:''o, <br /> CITY COUNTY BUILDING, RM 116 <br /> 210 MARTIN LUTHER KING, JR. BLVD. , •' <br /> y. <br /> MADISON, WISCONSIN 53703-3342 ; .4 <br /> PHONE 266-4266 FAX 267-1540 <br /> www.countyofdane.com/zoning <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: V e Q.('o► A N i:6v.o L,L L AGENT: <br /> ADDRESS: (j l 0 ( ()Wilk (j.l. ADDRESS: <br /> r5 <br /> PHONE: ( 0 AO —3\di 1 PHONE: <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROJECT: IN'Qom! C 1 t *(, C t CYl <br /> ESTIMATED COST OF CONSTRUCTION: $ 30C') + one) 00 (Structure plus mechanicals) <br /> 1 Rig_Ad__ 1,17 <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 1 / <br /> 5353 <br /> 4. LOCATION OF PROJECT 4, i m`I Z .CTW TV k) CfcSQ1.TAX PARCEL NUMBER <br /> SUBDIVISION OR CSM#(Certified Sury ap) IF ANY: in o Tel ( C-c,VV\ ' �.as 3 <br /> LOT NUMBER,IF ANY: 'C,Iy 1`r\ 6 <br /> 6. ZONING DISTRICT: (f <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. h <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 files. <br /> Examples of Floor Plans and Elevations attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? � V <br /> STATE SANITARY PERMIT NEEDED? Y / N IF YES, PERMIT# /'� <br /> APPROVAL FOR ADDING BEDROOM OR > 25% AREA NEEDED? Y( N J IF YES, PROVIDED? Y.y N/ <br /> 10. DRIVEWAY(or Culvert or Access) PERMIT NEEDED?G) N IF YES, PROVIDED? ON <br /> Many Towns require a Driveway Permit, County Highway Department or WDOT permits may be required for <br /> driveways with access to a County, State or US Highway <br /> 11. SHORELAND? Y FLOODPLAIN? Y() WETLANDS <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) <br />