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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 /> 6702 Pima Dr C Z <br /> OWNER ADDRESS (Number,Street,City,State,Zip) oning Status;CUP; <br /> Deed Restriction;CSM %JO <br /> 99 W Beltline Hwy Madison WI <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> M Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Capital City Neon Sign Co., Inc. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2714 Industrial Drive � 7C7C(City,State,Zip) (City,State,Zip) Setbacks <br /> Madison WI 53713 <br /> PHONE PHONE ,Site Plan approval from A, <br /> (608) 222-1881 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ccsigns @sbcglobal.net ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> 12 PARCEL 032/0709-361-9090-6 C-2 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '/a: '/a'/a: a Driveway permit <br /> ADDRESS: (state,county,tov <br /> 99 W Beltline Hwy <br /> CSM: LOT SUBDIVISION BLOCK/LOT �S'% permits <br /> 2-0 6 T ,•ubl' private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW // ( l <br /> PROJECT DESCRIPTION: 0 <br /> banner installation 5x20 building sign and 4.5'x15.5'ground sign j7 Zoning District +-' <br /> This project is a new building or structure. ? �/' 1 o ,HIV a (/ <br /> ❑ P j 9 Permitted Use Use? y <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERV CE: PERMIT NUMBER: Rural As•a r t h <br /> �E�WER �EPTIC (new/ stir " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ► (2- ri Wetland/Floodptain/ <br /> r it <br /> horeland (attachment) 'ti- <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR EmstonCoatroI permit <br /> Y D/ /�/f v ,j TOTAL SQUARE FOOTAGE: ,, (slopes,di'`�''tu�nce, / <br /> L� filling/access) '4ow <br /> 2ND FLOOR: 3RD FLOOR: 3 J <br /> 7 iirReview Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <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? 01'es EIVo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ❑No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? res Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONo <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 ❑No DDon't know <br /> 7. Is this to correct a violation? :Yes ❑NO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -► <br /> sas„z laroel c 2 O (9 Co — 1 3 Z <br /> 1 7 0- 0 4' — oODfyQ [d4 <br /> ry t ov <br />