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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. Pagelof2 DCPZP-2014-00822 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE SI,01-S-155 AGENT/CONTRACTOR NAME PHONE YOUTH SERVICES LLC (608-'4947.0 LaCrosse Sign Company (608)222-5353 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 1955 ATWOOD AVE 2242 Mustang Way (City,State,Zip) (City,State,Zip) MADISON,WI 53704 Madison, WI 53718 E-MAIL ADDRESS E-MAIL ADDRESS casey.behrend @briarpatch.org teresak @lacrossesign.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0709-363-2356-0 TOWN OF MADISON 36 SW NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 2720 RIMROCK RD subject to field verification.) LOT C.S.M.NO.or PLAT NAME 2 1BLOCK CSM 13543 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: CENSUS CODE C-1 Commercial Description:S'x 3.5'x 10'grd on-premise sign 329-Other District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. El Other Public ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION B-County Highway 9900 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. 4 YES X NO ❑ YES NO ❑ YES )4 NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 10 Sq.Ft. Sq.Ft.28 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error 1 Sq.Ft. Sq.Ft. PERMIT FEE I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the •nin• • ••• - • - Owner&Agent hereby agree to comply with all Dane County SIGNA RE: Owner/A.e• — , DATE: Ordinances.Any unauthorized change from the information or 4 / / �� J plans submitted will invalidate the permit. ' �` AI OFFICE t;6E ONLY (form version 03.00.07) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 10/23/2014 RLB ® YES ❑ NO DATE REVIEW:D 1 INITIALS 2nd INSPECTION DATE INITIALS Initials a r 1\� 56-kik.