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. % <br /> , p <br /> ZONING PERMIT APPLICATION wvvw.countyofdane.com . <br /> SUPPLEMENT to Wob-Ap # <br /> . <br /> ' <br /> . ' <br /> PROPERTY OWNER INFORMATION Cu TOMER TO PROVIDE <br /> OWNER NAME <br /> Golden Green Properties LLC <br /> Z ing Status;CUP, <br /> OWNER ADDRESS tNur,66,,Stteet C .State,/9) ed Restriction:CSM <br /> 1840 Beloit Avenue,Janesville,WI 53546 ariance(# <br /> HOME PHONE Cal PHONE TE-MAil ADDRESS <br /> 608-756-2318 1 paul@goldenoilcompany.com Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION Jld in9rides dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Excel Engineering Inc.-Eric Drazkwoski i Keller,Inc.-Dave Uttech Sit Ian including location <br /> AGENT ADDRESS i A- <br /> CONTRACTOR ADDRESS of -ell/septic <br /> 100 Camelot Drive 1 W204N11509 Goldendale Rd <br /> t•I- .. , , <br /> /City.State.Z ,..OI I{,Ity,St8te.-,p) ' Setbacks <br /> Fond du Lac,WI 54935 I Germantown,WI 53022 <br /> PHONE PHONE ---' 0 Pla pproval from <br /> 920-926-9800 262-250-9710 pli ble township. <br /> E-MAIL ADDRESS 1 E-MAIL ADDRESS <br /> i <br /> eric.d@excelengineer.com • duttech@kellerbuilds.com <br /> 1 r plans to scale <br /> PROPERTY/LOCATION INFORMATION (Mtp://accessdane.co.dane.wi.usl) <br /> PARENT L':6l 109380053 1;;;;;_,__R-._ C <-NT ZONING- -ACREAGE: levation of property <br /> n PARCEL. p61109380053 Br 061109384408 f.„.,, <br /> I 5.71 ron ge drawn to scale. <br /> ,--,NtAiBeR 4C.,„Silikis-proixtsecito-combine)t s','.' <br /> TOWNSHIP: SEC TIt", SO, <br /> Pleasant Springs 9 4: ....•i-, WA: NE . riveway permits <br /> (state.county,town) <br /> -ADDRESS' - <br /> 2741 Cty Hwy N Sa itary permits <br /> , <br /> CSEt A LOT -1-§i)eutvisloN i BLOCKCLOT <br /> Proposed <br /> (a blic,private) <br /> /11 Y., I • <br /> PROPOSED PROJECT INFORMATION z AR/REVIEW <br /> PROJECT DESCRIPTION, <br /> Fueling station with convenience store and fast-food restaurant with drive thru. - .ning District <br /> . Ill This project is a new building or structure. ' •ermitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> TANITARV SERVICE 1 PERMIT NUMSER. J R ral -.eress <br /> DEWER rx-TEPTIC 1 1 - 41 4 .xisting <br /> HEIGHT IN FEET ,NUMBER OF STORIES. iNtat incloding basemeril i <br /> 25 i 1 <br /> ....1._ ill firtla ../Floociplain/ <br /> ' oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outs,cle dimensions including unfinished area.attached garages and above grade decks or porches) , <br /> BASEMENT (1ST FLOOR ErosionControl permit <br /> 10,550 ! 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2NO FLOOR: 6/WELDOR i filling/access) <br /> 1 ..J 10,550 0 Review Locatf Survey N rap <br /> ESTIMATED C)NSTRUnearest dCTION COST: and ava' le options. <br /> -40 --11. ••••• ••••• -4. ...II. <br /> (Please round to ollar> $ 2,500,000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [)'Jo J)on't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes [ ,3 aon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Das 1. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dees 10 <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#11194/3685 (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DrIes laic, aon't know <br /> 7. Is this to correct a violation? OYes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Sack) -* -+ -4. <br />