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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 4 Z <br /> DEP Properties - Grant Signs (DP Industries LLC) Zoning Status;CUP; ` <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM / e)-8 3 <br /> 2810 Syene Road Madison,WI 53713 Variance # ) �A <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS S ill <br /> (608)838-7794 (608)219-8997 Dan©GrantSlgns.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION =•. .• des dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> self self U Site Plan in.luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS QE <br /> (City,State,Zip) (City.State,Zip) 0 Setbacks 5/C <br /> PHONE PHONE ZSite Plan approval from I Q 4 <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I4Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usl) A /� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: :i Elevation of property 2 PARCEL 032/0709-353-9931-8 C2 1.36 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: <br /> Madison SE -> %: .S W 1/4%: ,C Driveway permi <br /> ADDRESS: (state,coun CO 2810 Syene Road Madison, WI 53713 / �" <br /> CSM: LOT SUBDIVISION BLOCK/LOT 's+S:" '°ry permits <br /> 8,784 1 t; ; <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW::--,::, <br /> PROJECT DESCRIPTION: /Z / Q / / �. <br /> Reface existing pylon sign / (� zoning District <br /> This project is a new building or structure. 51? ,z <br /> • ❑ P 1 9 t�erml(ted Use � � h <br /> 4 This project is an addition/alteration to an existing building or structure. _`, 1'' -P; '} ,i'''',11:', .:- <br /> y.i" .;4,t—. x� K,', ,t. , <br /> SANITARY SERVI E: PERMIT NUMBER: RUQ� I Id , ,'F <br /> EWER r)EPTIC • 40(n hs 4 <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) r' } •',.'i- <br /> Z� / Wetland/Floodplain, . <br /> / Shoreland (atttachmient) �- <br /> AREA TO NEAREST SQUARE FOOT: E r± `t 6:,sk' 4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) roionCo- emtit ; <br /> BASEMENT. 1ST FLOOR: + p ' <br /> j TOTAL SQUARE FOOTAGE 4 F(slopes,disc trban&J. z <br /> fiflln� 'X';:*.',';'2ND FLOOR: 3RD FLOOR: ! � t <br /> O ReviewLocation Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. ' <br /> (Please round to nearest dollar) —' ♦ '— $ 750.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes rNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 10 aon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [Ho <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) ['Yes ONo ❑Don't know <br /> 7. Is this to correct a violation? DYes ✓INO <br /> APPLICATION MUST BE SIGNED <br /> (Continue-on-Back) i • i► <br /> 545-112(4/08) / O 2 !/ / / ? 3 S K.� h <br /> -- <br /> t 7 � � <br /> 700 <br /> 70 ,f- <br />