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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 /> Youth Services, LLC (Zoning Status;CUP; �Q"' <br /> OWNER ADDRESS(Number,Street.City,State,Zip) Deed Restriction;CSM 1 g t9 0 <br /> 2720 Rimrock Road Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)819-3755 casey.behrend @briarpatch.org in Site Plan drawn to scale ' 11 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions ) <br /> AGENT NAME CONTRACTOR NAME <br /> La Crosse Sign Company-Teresa Kiehl same as agent Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 0 <br /> 2242 Mustang Way <br /> (City,State,Zip) (City,State,Zip) Setbacks 37.5A <br /> S <br /> Madison,WI 53718 <br /> PHONE PHONE agf_Site Plan approval from/V <br /> (608) 222-5353 applicable township. �`t <br /> E-MAIL ADDRESS E-MAIL ADDRESS '� <br /> teresak @lacrossesign.com �-l�t'Floor plans to scale k <br /> 1( <br /> PROPERTY/LOCATION INFORMATION (http:llaccossdane.co.dane.wi.us!) ✓ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ealevation of property <br /> ElPARCEL 0321/0907-363-2356-0 c1 0.78 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Madison 36 1/4; SW 1/1/; SW Drivew- •-rmots <br /> (stet: COU 1 ,town) <br /> ADDRESS: <br /> 2720 Rimrock Road CC T P <br /> CSM: 13 543 LOT 2 SUBDIVISION BLOC � permits <br /> , <br /> • 1•,private) <br /> PROPOSED PROJECT INFORMATION - STAFF REVIEW' <br /> PROJECT DESCRIPTION: Q , <br /> Install 1 D/F internally illuminated ground sign. p )� �t /0 / Q n� Zoning District t - <br /> . i0 This project is a new building or structure. Permitted se? <br /> ❑This project is an addition/alteration to an existing building or structure. ^4 ff tf <br /> SANITARY SERVIC : PERMIT NUMBER: RL1ral ci. ss <br /> $VJER I-- EPTIC - (new <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10.0 <br /> / , Wetla /Fl <br /> • oc plain/ <br /> AREA TO NEAREST SQUARE FOOT: Organ• attachment} ; <br /> T <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOSlonGontfel per__., <br /> 2 ,`, TOTAL SQUARE FOOTAGE: { (slopes,disturbance,- <br /> 2ND FLOOR: 3RD FLOOR: p fillinglaCCess), <br /> 20.0 _. <br /> Review L• on Survey <br /> ESTIMATED CONSTRUCTION COST. and ava able:options <br /> (Please round to nearest dollar) ♦ --► --► '- -i $ 10,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? []Yes (Zlo is Don't know <br /> 2. Is there a wetland or floodplain on or near the property? []Yes No IN Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E✓Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? []Yes air) <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 ao fDon't know <br /> 7. Is this to correct a violation? [Yes ✓[�lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(UV} <br />