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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 /> Peterbilt Wisconsin-Madison/Charles M. Jorgensen <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4205 Anderson Road, DeForest, WI 53532 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)241-4101 (262)617-9192 ejorgensen @jxe.com ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tracy Jonas Grant Signs/Sign Productions, Inc. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4705 Rib Mountain Drive 5119 Terminal Drive <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Wausau, WI 54401 McFarland, WI 53558 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (715)359-4216 (608)838-7794 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tjonas @jxe.com emarty @signproductions.com ❑ 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 /> Li PARCEL 014/0810-093-8572-0 C-2 8.214 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Burke 9 �/a: SW %1/4: NW ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4205 Anderson Road, DeForest, WI 53532 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 7441 2 NA NA (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> LOT 2 CSM 7441 CS38/185-191 R27321/30836-5/4/94 DESCR AS SEC 9-8-10 PRT NW1/4SW1/48SW1/4NW1/48 PRT INTERSTATE PARK PLAT(8.214 ACRES) ❑ Zoning District <br /> INCLUDES PRT VAC ANDERSON RD IN R27328/9 EXC 3252117 SURJ TO ACCESS ESMT IN DOC 83353409 <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> o This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA T R TS FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinishe are c es and above grade decks or porches) <br /> BASEMENT: 1ST F R: ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -P. XXX and available options. <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 ol No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes al No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes of No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 08/19/04 o 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 o No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes is No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ♦ ♦ -* <br />