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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ALBION, TOWN OF <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 624 ALBION RD,EDGERTON,WI 53534 Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> (608)884-8974 albion @milwpc.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SAME AS OWNER ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State.Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0512-223-2132-3 RE-1 2.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • ALBION 22 1/4. SW 1/41/4. NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 612 CAMPUS LANE <br /> CSM:• LOT 31 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> CONCESSION STAND FOR THE BASEBALL DIAMOND ❑ Zoning District:,::1' <br /> . 4 This project is a new building or structure. .-' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address "', <br /> EWER FIEPTIC (new/existing) " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑"Wetland/Floodpiain! <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 1ST FLOOR: ErOSIOrtcOM Di permit <br /> Zgo j TOTAL SQUARE FOOTACE: j {slop disturbance, <br /> fing/a* ) <br /> 2ND FLOOR: 3RD FLOOR: zsg <br /> i eview Location Survey - <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ r 0 and available O?7iQnS <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ['Don't know <br /> 3. Have you talked with the township about your project and are ther,ip<aen, nt? fYes ❑No <br /> 4. Has there been a zoning permit issued for this property titbiast 5'yiyars? JYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(pt°tltion/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 1 igl) ['Yes ONo ❑Don't know <br /> 7. Is this to correct a violation? 1\\ 12 No <br /> t.1- U <br /> " <br /> f'''''''''' ` APPLICATION MUST BE SIGNED <br /> V'l''c -( Continue on Back) <br /> 545-112(4/08) <br />