DCPZP-2001-01305 - Laserfiche WebLink

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OUTDOOR SIGN INSTALLATION APPLICATION AND PERMIT Wisconsin Department et Transportation intsrstate and Federal Aid Primary Highway Systems . - aµ-t7 12aa Applicant Instructions: Submit the following to the District Office identified in the block entitled.'Mail Completed Permit Application To:' A 3 copies of this application with all entries completed down to broken line; B. 3 copies of a sign sketch lIhistiiating the size (by dimensions), shape, color scheme and message of the proposed display; C. 3 copies of a site plan drawing. detailing sign positioning with respect to the highway, directions) of the sign's facing(s), and whether the display veil be on a budding or free standing. The location for On property signing shall be referenced(distance shown) to the nearest part of the building tart which the activity is conducted or managed. Include on the drawing the locations of property lines and development features, such as ausbomer parldng lots; a i copy of documentation from the jurisdictional zoning authority to prove how the property is zoned: include.date current zoning was esia eel,• it no zoning has been assigned to the property, include a statement from the jurisdictional zoning authority to the effect that the land is unzoned; • E. A check or money. order(no cash) made payable to: Wisconsin Dept. of Transportation to cower the required permit fee: (See Item#6 on back.) 1.NiplwslrNO. . 3. El Town II City wia.ge- 4.FsplMaySide V. ooh 0 jt OF: Sf/ , ' - ■south ❑w.et •5.Las+d=kin(Pled Location C- a (cam ! 99 q s�be located within the �.r a, arses, Proposed sign meelsaa Owl zoning requiremerds —a-- C 13 1N lid y Es 0 ND Township D % Nett Range g D Wwt 7.Oi stance beaver Proposed sign sib and owed intersecting highway,road or sheet . q,4 714kt g IQ test d m.or»at Rom • pd.nd y road measured from) ilea - �w.acN°"h..s°ut'► - a Distance tom the*Mew right deny One - a Sign to race(compass direction) 10.Sign Urination ta Steady got • • SO a Teen /t C Eel1c -1wesfc 0 N . 11.Name and address&pesworwnpaywhowal instal assig aapprwad 1T�4�J �uT��f �vef 12hhstaaeraorhsemmbrrnme,sosea� r ill: Craft JuII; ra-.9. .E. eadyer Ad, ' Jcierrmre 5(a,le - triad licit, iv/ • 39/3 I 69 13. Sign Category - Ili. Sign Type - ID More than 660 feet from,highway rigid of vary 0 S Face II."V May apply bo any of the following; ❑Back to Back- ❑Over Under • ❑On Advertised Property Free Standing ❑Side by side ❑On Advertised Property and on budding 14 Apps wn*Name Telephone❑on Advertised Property for guidance of internal traffic - /lc i a in s O c t td fro i Ad uer/-i S'I.ng teen#7 on back) skeet Add ass �Off Advertised Progeny(Must complete Skeet a Club /Oa E'. . �ady,er Ad. • D Religious Nodes C3y.state.rtp ❑Sign on offcialy designated school bus stop shelter • . /Y!a e I t so ft (,v/ 53 r7/3 Affidavit from school officials required t i eon To or Dart Mac Joel Seaman, Sign Permit Coordinator ❑Directional as defined by Subsec. Trans.201.05 Admin.' dmin Code Technical Services Section (Must complete itern d-on b Wisconsin Dept. of Transportation If boor is checked.advertiser sign below. 2101 Street • ❑Official sign (City. Wage, Town, County, State' official to be applicant) Madison,Wright ht treat If beer is dhedaed,official sign betohwr. . 53704 • The undersigned applies requests permission to install and/or maintain signing as-described. 4 ., 3- 14-ol x f_ >;�,. (14.Advertiser OR ooiciar Serahee) • / (t7.- Appaanq (Date) PERMIT Subject to compliance byte applicant ad requirements of s.84.30 Wis.Stets.,with Ch.Trans.201 Wis.Admin.Code,with other statutes and codes applying. and W h all standard and special provisions on the reverse face or attached,permit approval is gran'.`d to authorize installation and maintenance of the specific advertising or informative display described at the precise location defined. This-permit will expire one year after the Permit Issuance Date if the sign permitted here is not installed by that time,unless the Deparbnent has granted a time extension in response to written justifications. Access from the travel lane Cr any Interchange ramp of any Interstate highway or any other controlled access highway for the installation,maintenance or repair of the sign is expressly prohibited. This Permit is Revocable. Completed by Wisconsin Department of Transportation: R.P.Number Sign Area(sq.R) Chealtumber Fee Received Pesnitkssuance Date PennitNumber 8 G -+6.5 7 ' 5'gC1 /7y// $ SO O4�` `'-�05-c)/ I .3 -r 7)�,/_c i Rocca Number / I� C / i7s C I By -,- • (Approval for Director at Highway Operations)