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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ' O <br /> JACS Property Madison East, LLC 1 1 ci S <br /> — — — 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number Street City State Zip) <br /> 6160 Sun Valley Parkway,Oregon WI 53575-2531 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE <br /> __ Variance(# " ) <br /> �E-MAIL ADDRESS <br /> (608)239-9151 martymuffier@charter.net <br /> NI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Keller.Inc.-Bob Poch Keller,Inc.-Bob Poch <br /> ---- 12 Site Plan including location <br /> AGENT ADDRESS <br /> PO Box 620 CONTRACTOR ADDRESS of well/septic <br /> PO Box 620 <br /> (City,State.Zip) (City State Zip) — Q Setbacks <br /> Kaukauna,WI 54130-0620 Kaukauna,WI 54130-0620 <br /> PHONE PHONE IN Site Plan approval from <br /> (920) 427-4458 (920) 427-4.4.58 applicable township. N/A <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> bpoch @kellerbuiIds.com bpoch@kellerbuilds.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdene.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE 12 Elevation of property <br /> DPARCEL 0710-041-4022-2&0710-041-4044-6 <br /> NUMBER , 1ir'C^ Z. 1.16 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Blooming Grove 4 1h: NE 1%IA: SW igi Driveway perm' <br /> ADDRESS: (state,county town TBD <br /> 4008 Milwaukee Street <br /> CSM 1,503 LOT 2 (SUBDIVISION —'BLOCK/LOT 0 Sanitary permits TBD-TOf1N <br /> Clyde A Gallagher Garden 1/4,5 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Meineke Car Care Center r =_ ❑ Zoning District <br /> • Fl This project is a new building or structure. ❑ permitted Use? <br /> DThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER I ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 28.0 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT:— Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> 7,047.0 j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR filling/access) <br /> 7,047.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ..* ♦ ♦ -•► ♦ 1,000,000 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? Dyes D✓No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes t/ o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes _lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes FdNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 1"95 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DYes ED10 DDon't know <br /> 7. Is this to correct a violation? DYes ONO <br /> APPLICATION MUST BE SIGNED <br /> 545-112 I4/D ) (Continue on Back) <br />