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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 /> Road Ranger, L.L.C. ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 4930 East State Street,Rockford, IL 61108 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (815)540-9929 MBourgault @RoadRangerUSA.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Road Ranger,L.L.C.,Attn:Marc Bourgault Road Ranger,L.L.C. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4930 East State Street 4930 East State Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Rockford, IL 61108 Rockford, IL 61108 <br /> PHONE PHONE <br /> [..]Site Plan approval from <br /> (815) 540-9929 (815) 540-9929 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MBourgault @RoadRangerUSA.com MBourgault @RoadRangerUSA.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0611-094-8666-0 C2 4.83 frontage drawn to scale. <br /> NUMBER _ <br /> TOWNSHIP: SECTION: <br /> Pleasant Springs 9 1/4: WA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2762 County Highway N, Cottage Grove, WI 53527 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 10,634 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Replacement of a canopy sign-NORTH (1 of 2) ❑ Zoning District <br /> . ['This project is a new building or structure. ❑ PermittedUse� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address _ <br /> EWER rEPTIC (new/existing) ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetiand/Floodplain/ <br /> • - — Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT. 1ST FLOOR: <br /> 1 TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available o tions. <br /> (Please round to nearest dollar) -+ -+ ""+-+ � -i -i $ 7,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes BINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes rNo <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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -♦ -► <br /> 545-112(4/08) <br />