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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 <br /> Road Ranger ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2762 County Highway N Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Li Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <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 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Addison, IL 60101 Addison, IL 60101 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 630-543-9490 630-543-9490 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> Permit id. e i•n . om Permit id. e i•n •m ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: 'ta: ❑ Driveway permits <br /> //4: <br /> ADDRESS. (state,county,town) <br /> 2762 COunty Highway N Cottage Grove, WI ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ,` <br /> PROJECT DESCRIPTION• s w 'M <br /> Replacement LED Price Center for large highway sign '' & " 13,ktir*,Afiw <br /> . ❑This project is a new building or structure. `' s ?� j , <br /> ®This project is an addition/alteration to an existing building or structure. >T e " ire �_f , <br /> SANITARY SERVICE: PERMIT NUMBER: TP>ri'41‘1,,,Atit <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - ,1f, - ,�� ,7 <br /> ,-- .i a g a s ;-- <br /> AREA TO NEAREST SQUARE FOOT: ;, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i ,R 4?�, ii,�'p' <br /> �� pia 1 ` <br /> BASEMENT: 1ST FLOOR: �t ,' .s <br /> 4, TOTAL SQUARE FOOTAGE ,j, g . ' 'i = <br /> € 'I sa r i <br /> 2ND FLOOR: 3RD FLOOR: _ , <br /> ESTIMATED CONSTRUCTION COST: ,i, .v <br /> (Please round to nearest dollar) "� '��_ 1 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No I Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Li Yes II No Li Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®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 rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Li No ®Don't know <br /> 7. Is this to correct a violation? ❑Yes I No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ —► <br /> 545-112(4/08) <br />