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DANE COUNTY ZONING PERMIT DCPZP-2016-00482 Page 1 of 2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE JEFF ROSEN LACROSSE SIGN CO (608) 222-5353 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 2510 W BELTLINE HWY 2242 MUSTANG WAY (City,State,Zip) (City,State,Zip) MADISON, WI 53713 MADISON, WI 53718 E-MAIL ADDRESS E-MAIL ADDRESS jeffrosen @rosennissan.com laura.dyer @lacrossesign.com PARCEL NO. TOWNSHIP SECTION 1/4 1/41/4 0709-343-8835-0 TOWN OF MADISON 34 SW NW PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 2510 W BELTLINE HWY subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 3 CSM 13693 ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE C-2 Commercial 1.64 Description:wall sign 329-Other District Category ❑ Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. o Other: Public ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION A-US or State Highway ❑ YES 0 NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 18.75 Sq.Ft. Sq.Ft. PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR #Error 0 Sq.Ft. Sq.Ft. PERMIT FEE $100.00 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more inf. ;:i< , sit;tl ::®epectment of Natural Resources web w page at ww.dnr.state.wi.us or contact the Depa - - 4atural Resoljlrces Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning aiucnances..' Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or �� plans submitted will invalidate the permit. o • Y-1 e OFFICE USE ONLY (form version 03.01.00) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 08/02/2016 SSA1 ❑ YES ® NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: