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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 /> Enterprise Rental ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 200 W Beltline Hwy,Madison,WI 53713 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Shulfer Architects,LLC(Steve Shulfer) Supreme Structures ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1918 Parmenter St.,Suite 2 2906 Marketplace Dr. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Middleton,WI 53562 Madison,WI 53719 <br /> PHONE PHONE 4 Site Plan approval from <br /> (608) 836-7570 (608) 224-0777 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sjshulfer @shulferarchitects.com dan @supremestructures.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.c.o.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONIN� fr ACREAGE: <br /> ❑PARCEL „Q2D9-36 OO122 C2 /few 6.08 frontage drawn to scale. <br /> NUMBER _ <br /> TOWNSHIP: SECTION <br /> Town of Madison 36 ?1/4: SW 1/41 4: NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 200 W Beltline Hwy, <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 2 PLA T (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF: +IEW <br /> PROJECT DESCRIPTION: <br /> New sign band on front(south)side of building �© :Of1 hg Di <br /> ❑This project is a new building or structure. 0 04110100100/: 'Y <br /> r4This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERV E: PERMIT NUMBER: 0 EWER �EPTIC ewtei` ng <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not induding basement) <br /> 16.0 1.0 0 WotlanOloodplaint,, <br /> Shorelandl`(attachment) :. <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 /> 33,600.0 4, TOTAL SQUARE FOOTAGE: <br /> �i`thgfa <br /> 2ND FLOOR: 3RD FLOOR: <br /> 33,600.0 <br /> i 141/10 t onl n►ey ' <br /> ESTIMATED CONSTRUCTION COST: $ d< <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ['No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Nlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓❑Yes Efrslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ✓No <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 QNo ['Don't know <br /> 7. Is this to correct a violation? QYes ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —■ <br /> 545-112(4/08) <br />