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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Wob•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Kippley Rental Properties LLC <br /> (l Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction, CSM <br /> 7652 Conifer Court Deforest WI 53532 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)842-3040 (608)575-1143 bill @ptatrucks.com Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> La Crosse Sign Company same as agent Site Plan Including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2242 Mustang Way <br /> (City,State,Zip) (City,State,Zip) C Setbacks <br /> Madison,WI 53718 <br /> PHONE PHONE O Site Plan approval from <br /> (608) 222-5353 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> teresak@lacrossesign.com E Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accossdane.co.dano.wLusQ t� l Elevation of property <br /> PARENT PARCEL NUMBER: CUR•ENT ZONING: ACREAGE: <br /> El <br /> PARCEL 068/0910-092-8510-0 C-2 DCPRE7_-0000-01666 2.92 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> T0NR10E-TOWN OF WINDSOR 9 1: NW 1/41/4: NW Driveway permits <br /> ADDRESS: - (state,county,town) <br /> 7652 Conifer Court, DeForest WI 53532 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 11,363 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Install 1 single faced internally illuminated pylon sign-Finished height is 27'measured from the cenerline of the road Q Zoning District <br /> . IN This project Is a new building or structure, ❑ Permitted Use? <br /> ❑This project Is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: IJ Rural Address <br /> EWER DEPTIC (neW/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) <br /> 27.0 Q Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> Shoreland (attachment) <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q Er°51°ICOntrQtpermlt' <br /> 4, TOTAL SQUARE FOOTAGE: 4,( slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: flliltl /aCCes <br /> 200.0 U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> and av <br /> ♦ available options: <br /> (Please round to nearest dollar) ♦ ♦ $ 30,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓No Don't knoA. <br /> 2. Is there a wetland or floodplain on or near the property? [Yes JNo [Don't know <br /> 3, Have you talked with the township about your project and are they in agreement? [Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ONo <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) Dyes ONo ODon't know <br /> 7. Is this to correct a violation? QYes 4No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -- —► -+ <br />