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' DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDIN6, RM 116 ,. <br /> 210 MARTIN LUTHER KING, JR. BLVD. <br /> MADISON, WISCONSIN 53703-3342 <br /> PHONE 266-4266 FAX 267-1540 `,-VCa}35.- . • <br /> www.countyofdane.com/zoninq - <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> 1. LANDOWNER: 1.-01.0)• ''`L Cc�P.�� AGENT: <br /> ADDRESS: '1 a N-)li A ADDRESS: ,-11-1 -13 N)L . OQ-O <br /> U QE G()Al .,)►S 5-35 7 5' 0 9-EC,p ri .►��S 51615 <br /> PHONE: Co — $3 S- -7 75 PHONE: (001 <br /> EMAIL: EMAIL: <br /> 2. TYPE OF PROTECT: -gCMDDEL ADD NEW NEW nE -K LI/ eAiP <br /> ESTIMATED COST OF CONSTRUCTION: $ q0,DOb (Structure p/us mechanicals) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: L v ` CI w 1 <br /> 4. LOCATION OF PROJECT: � q <br /> TOWNSHIP,SECTION,1/41/4 � cv r /6-0 5 Ee-- 9-4 _ <br /> TAX PARCEL NUMBER 04a- 0 5 Oq -aki/ - 9 a 7 0-- <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: <br /> LOT NUMBER,IF ANY: <br /> X <br /> 6. ZONING DISTRICT: / \ <br /> 7. SI I t PLAN: 'A site plan must be drown 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 /> $ FLOOR PLANS AND ELEVATION VIEWS (front, sides, rear): A copy will be kept in Zoning Division files. <br /> Examples of Floor Plans and Ele^va/tio�nss attached. <br /> 9. PUBLIC SEWER OR PRIVATE SEPTIC SYSTEM? AJ <br /> STATE SANITARY PERMIT NEEDED? Y / N IF YES, PERMIT# <br /> APPROVAL FOR ADDING BEDROOM OR > 257. AREA NEEDED? Y / N IF YES, PROVIDED? Y / N <br /> 10. DRIVEWAY (or Culvert or Access) PERMIT NEEDED? Y 4C7 IF YES, PROVIDED? Y / N <br /> Many Towns require a Driveway Permit;County Highway Department or 14/DOT permits may be required for <br /> driveways with access to a County. State or US Highway <br /> 11. SHORELAND? Y N FLOODPLAIN? Y c7 WETLANDS Y I� <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) �� <br />