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m <br /> ZONING PERMIT APPLICATION www.countyofdanccom SUPPLEMENT to Web-A * <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Wal-Mart R.E. Business TR <br /> Zoning Status; CUP: <br /> OWNER ADDRESS ;Number.areet City.State.Zip) Deed Restriction; CSM <br /> 2001 SE 10th Street.Bentonville,AR 72716-5570 Variance(# ) <br /> HOME PHONE CELL PHONE ADDRESS <br /> [E-MAIL 1E <br /> 1 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ,CONTRACTOR NAME <br /> 1 , <br /> Todd Fennoman , Dick's Refrigeration,Inc. 1:1 Site Plan including location <br /> AGENT ADDRESS ;CONTRACTOR ADDRESS of well/septic <br /> 348 E.Hemenway Lane ' 348 E.Hemenway Lane <br /> (CAy St■ler': ...1r/ I(City,State,29) 0 Setbacks <br /> Edgerton,WI,53534 I Edgerton,WI.53534 <br /> PriONL t-PHONE D Site Plan approval from <br /> (800)424-4817 (800)424-4817 applicable township. <br /> -:— <br /> EMAIL ADDRESS I E-MAIL ADDRESS <br /> dick-dieksrefrig@charter.net 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpalaccossdane.co.dane.wLuol) <br /> ARE..'_ 1 PARCEL NILIMBER Ci.IRRENT ZONING' -ACREAGE' 0 Elevation of property <br /> n PARCEL . <br /> NjtlRE 25110810-334-0407-1 frontage drawn to scale. <br /> yP <br /> TOWNSHIP 1 SECTION. <br /> . 0 Driveway permits <br /> City of Madison l 1/4: 1/41/4: <br /> (state,county. town) <br /> 4198 Nakoosa Trl <br /> D Sanitary permits <br /> csm LoT .sUBDIVISION TELOCKILOT <br /> (public,private) <br /> , ,, <br /> PROPOSED PROJECT INFORMATION 41.400.REviEw, <br /> PROJEC.,T DESCRIPTION <br /> CRANE to set Refrigeration Racks and Condensers on Rooftop of Wal-Mart Store Addition, LI Zoning District <br /> E]This project is a new building or structure, 'LI Perinitteiitse4:t 4, <br /> E This project is an additionialteration to an existing building or structure. A. . <br /> ' < ' <br /> sANI,AP Y SERVICE !PERMIT NUMBER ,,,,ci Ruts!Address <br /> rk.v.v&R CIF:.--ie.:, . <br /> (new/existing) <br /> FIG-'IN;`•ET 1 NIAISER Or STOKES' iNtr,mcluding rxasernerl/ <br /> 170.0 , 0 Witiand/Floodpiain/ . <br /> horeferwi, (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> Outside d,rnertsns itcluding untnist:ed area;attuned garages and above grade decks or porches) ,---. .... <br /> BASEVEN r ST FLOOR I U'trosicitiCorititi permit <br /> 1 4, TOTAL SQUARE FOOTAGE: 4, ??. (slopes,disturbance. <br /> i <br /> 2ND- IR 3RD --t- filling/access) <br /> 0 Review Location Stivey <br /> - <br /> EST MATED CONSTRUCTION COST, --, -10. $ <br /> ■ 4, and available options. <br /> -- --• -4. - <br /> 1 (Phase 3tind to nevest oollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes LIN o ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Lfres ON° ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes 0No <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 Elivo ODon't know <br /> 7. Is this to correct a violation? DYes ON° <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -, -. <br />