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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 /> Golden Green Properties LLC Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1840 Beloit Ave,Janesville,WI.53546 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)756-2318 (262)409-5565 ted©goldenoilcompany.com Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ted Gement 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 11800 Burlington Road <br /> (City,State,Zip) (City,State.Zip) Q Setbacks <br /> Kenosha,WI.53144 <br /> PHONE PHONE 0 Site Plan approval from <br /> (262) 409-5565 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tedr'goldenoilcompany.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/Iaccessdane.co.dane.wi.ust) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> PARCEL 06111-093-8425-0 C-2 5.70 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Pleasant Springs 9 1/4: sw 1/41/4: 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2763 County Road N <br /> CSM: 14,726 LOT SUBDIVISION BLOCK/LOT <br /> 14 1 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> reface existing pylon sign and add two directional signs <br /> . 151 This project is a new building or structure. =' <br /> QThis project is an addition/alteration to an existing building or structure. �$ ; <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER JEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <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 /> TOTAL SQUARE FOOTAGE: 4 <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: $ <br /> (Please round to nearest dollar) •• —to -- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes Eio 1 e• 't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [JYes Dio <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) QYes QNo A'• t know <br /> 7. Is this to correct a violation? QYes 0No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4108) <br />