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DANE COUNTY ZONING DIVISION <br /> CITY COUNTY BUILDING, RM 116 ; <br /> 210 MARTIN LUTHER KING, JR. BLVD. 1 <br /> MADISON, WISCONSIN 53703-3342 <br /> PHONE 266-4266 FAX 267-1540 46.0114-e- <br /> www.countvofdane.com/zoni nq <br /> ZONING PERMIT CHECKLIST <br /> PLEASE FILL IN AS MUCH INFORMATION AS POSSIBLE. <br /> iU;10" O(5:SA CC Ct- <br /> 1. LANDOWNER: Co ti r1 ASa' &ATZCo0 AGENT: <br /> ADDRESS: Li 3 71_ !+'I Jtp S T, ADDRESS: <br /> PHONE: G' 0 ? — Z Z q— 0 -L c 1 PHONE: <br /> EMAIL: -J e -FRe 14 L G1 SC -J (9' MAC, Ccan EMAIL: <br /> 2. TYPE OF PROJECT: /} C< .i J o R y (3 i =C O N(, - u P C;.%) 11-2R... zt c_N i c. S N C 7 C f< <br /> ESTIMATED COST OF CONSTRUCTION: $ S 1 0 n) (Structure plus mechanicals.) <br /> 3. ADDRESS OF PROJECT, IF KNOWN: 1. S i`^C i S rf ( ` ``� <br /> 4. LOCATION OF PROJECT: <br /> TOWNSHIP,SECTION,1/41/4 1 0 c '-) ✓r © ""1") <br /> TAX PARCEL NUMBER 0 z-d''/ 4 d i 0 O 5 3 — u 3 v ? — 3 <br /> SUBDIVISION OR CSM#(Certified Survey Map),IF ANY: <br /> LOT NUMBER,IF ANY: q b (3 L C'`K- <br /> 6. ZONING DISTRICT: R 3 <br /> 7. SITE PLAN: *,4 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. <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? P f� ? C <br /> STATE SANITARY PERMIT NEEDED? Y / N IF YES, PERMIT# <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? Y / N IF YES, PROVIDED? Y / N <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?C) N FLOODPLAIN? Y / N WETLANDS Y / N? <br /> 12. TOTAL AREA OF LAND DISTURBANCE (Square feet) (I <br />