Laserfiche WebLink
Z-© 0070 °01 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C- Z <br /> Road Ranger IM Zoning Status; CUP; 2 r y, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM �,3a <br /> 2762 County Highway N Variance(# ) / <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS � <br /> tki <br /> Site Plan drawn to scale 4 ,C /y <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions D(C�3 L/ <br /> AGENT NAME CONTRACTOR NAME �'F'�( 7 <br /> Doyle Signs, Inc. Doyle Signs, Inc. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 232 w. Interstate Road 232 W. Interstate Road 1 1,1 ,� / <br /> (City,State,Zip) (City,State,Zip) (� Setbacks 5 "..-ti IV <br /> Addison, IL 60101 Addison, IL 60101 ��// <br /> PHONE PHONE d1Q Site Plan approval from A <br /> 630-543-9490 630-543-9490 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> M. Floor plans to scale <br /> Permits .do e i•n . om P- RH•t .d. . •m <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: „ <br /> '/a: '/<'/a: O M D ' - ay permits IY/ <br /> dirADDRESS: county,town) <br /> 2762 COunty Highway N Cottage Grove, WI ►r Sanitary pe its /1//41 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public rivat ) <br /> PROPOSED PROJECT INFORMATION E -`' fm <br /> PROJECT DESCRIPTION: <br /> Replacement faces for large highway sign 12' x 12' `. <br /> ,E,Ei' �g <br /> Li This project is a new building or structure. Ei` <br /> I This project is an addition/alteration to an existing building or structure. , , i pi ilopt!SANITARY SERVICE: PERMIT NUMBER: ` i <br /> ❑SEWER ❑SEPTIC i, J -,: <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �' c <br /> A o a a e e <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) E <br /> r P 1 w5 1F &1 �P <br /> BASEMENT: 1ST FLOOR , y°E <br /> 4, TOTAL SQUARE FOOTAGE: 4, ,,,E, <br /> € �° fi. v�` <br /> 2ND FLOOR: 3RD FLOOR: ;E a <br /> SEE <br /> ESTIMATED CONSTRUCTION COST: E° , ;a A <br /> ". $round to nearest dollar) sV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? LID Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I Yes ❑No <br /> 5. Is this project associated with a rent / Ion/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see CI ❑Yes ❑No ®Don't know <br /> 7. Is this to correct a violation? ❑Yes Q No <br /> JAN 1 5 2009 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -4 <br /> 545-112(4/09) <br /> DANE COUNTY PLANNING&DEVELOPMENT <br />