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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Madison Metropolitan Sewerage District <br /> boning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 523 East Main Street Madison,WI 53703 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)222-1201 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Heidi Horejs J.F.Ahern Co. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 855 Morris Street 855 Morris Street <br /> (City,State,Zip) (City,State,Zip) [l 'Setbacks <br /> Fond du Lac,WI 54935 Fond du Lac,WI 54935 <br /> PHONE PHONE Site Plan approval from <br /> (920) 921-5517 (920) 921-9020 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> hhorejs @jfahem.com © lo r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑PARCEL 071031386005 A-2(2)DCPREZ-2014-10732 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Blooming Grove 31 1/4; SW 1/h: NW Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4760 East Clayton Road <br /> Nt Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pump Station 11 Addition ❑ Zoning District <br /> . ❑This project is a new building or structure. 'Permitted Use ?V ►tt. <br /> r4This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �.,,�,� `,, <br /> 14.0 1.0 `wetiarld/ Ioodplainf <br /> AREA TO NEAREST SQUARE FOOT: <br /> horeland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> 4rosionControl permit <br /> BASEMENT 1ST FLOOR: p <br /> 0,0 280.0 , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> f'tllingiaccess) <br /> 0.0 0.0 280.0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -+ ♦ -♦ $ 54,600.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓Yes EiVo ❑Don't know <br /> 3. Have you talked with the township about your project a ey in agreement? ❑Yes ao <br /> 4. Has there been a zoning permit issued fok.tia. Vppk i tepast 5 years? [Yes DINo <br /> A cam.., <br /> 5. Is this project associated with a rezon lance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) �� ❑Yes 'rip! o [:]Don't know <br /> 7. Is this to correct a violation? kN [Yes i,-.)0 <br /> ��OPMENt <br /> P� gAGt.'C APPLICATION MUST BE SIGNED <br /> 545-112(4/08) CABS COV (Continue on Back) ♦ -► <br />