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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER 4o 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 /> Cl 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-MAIL ADDRESS <br /> Permit 'd. e i! iii '°4u is ado - i• em ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE TZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ,/. ,/4,/: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 2762 COunty Highway N Cottage Grove, WI ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION t t 717f <br /> PROJECT DESCRIPTION' S <br /> Replacement face for Diesel Canopy sign <br /> • ❑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. <br /> & 1C � � , <br /> LI SEWER ❑SEPTIC � f � r( e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) a r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ ♦ ♦ ♦ °-► ♦ t' ° I s t 3 <br /> (Please round to nearest dollar) , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes I No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 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 ❑No ®Don't know <br /> 7. Is this to correct a violation? LI Yes I No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —I. —r -4 <br />