DCPZP-2017-00015 - Laserfiche WebLink

Home Browse Search

RECEIVED OUTDOOR SIGN INSTALLATION APPLICATION AND PERMIT Mail Application*ant rat Office Wisconsin Department of Transportation DT1680 6/2006 s.84.30 Wis.Stats. This Permit is Revocable. OCT 3 0 2.015 For Locations Adjacent to Interstate and Federal Aid Primary Highways and the National Highway System DTSD SW Region MADISON Applicant-Sign 0 ner Area Code-Telephone Number 'Z-t- L _• rile ' Li c WA - 2-0— g ,14.-3 Address City,State,ZIP ode 2�gI Sr. �i q2- Rt. i3Vtio WI c <0--172.- E-Mail Address X 1 A ♦A 101 2- 1 t C U.knc . 2 @-pam Le,Vg);idit cti✓-h 3.lr3i,7--- (Permit Applli TI ature) (Date) An agreement/lease with the landowner that allows installation of the described sign and continued access to the sign site must be obtained prior to approval of this application for all categories except on-premise. Nothing herein requires a property owner to have or to retain a sign on their land. Landowner Name —Print Area Code—Telephone Number Z i-L fire ._r--hc,. ILL(- (00Z 4351•-S`-tbe, Address,City,State ZIP Code ZSSI SICA46 0-v,". c 2-- 1-4:1, etc.% 1/V i. 53572 By my signature,I acknowledge that I am aware of the Permit Conditions and Restrictions listed herein and I affirm there are no easements or restrictions that would prohibit this sign from being erected. (La I• - Signature) (Date) Installer Nam License Number w,A ft, deAtimuvoi tcLt? Ilitalo-rN Address,Ciiy,State ZIP Code i+�� Highway/s y s i i s i County - ix tLk City irtoU Village. Hi❑Ny$ S ❑E ❑W Land Zoning(Supply proof) Date of Zoning Sign Eaca i V 4 Lc I �� - t3% �cy'(y t ❑S ❑E ❑W ❑N\S E\W Sign Location(Legal Description) 5c., 114 of the V C% 114 of Section 13 Township North,Range CO IXLEast ❑ West Distance from sign to the pavement centerline of the closest road that intersects with the highway along which the sign will be erected I a ,':'''.f: . . S i.A1, r F .r -, � 9rr,> �df < } � (Feet) (East,West,North,South) (Identify road measured from) - ■ Distance from highway right of way to sign Sin Illumination Height Above Ground Level(HAGL) 4 ft. Steady Light ❑No Light 0 Changeable Message _ i'tX• ft. _ Sign Category and Fee Sign Design On Premises Free Standing $175 2_. Type 1 (Choose one) Type :(CLose one) r<4n-f temises4n=Bra+Iding -$175---,S*1 ❑ Single Face ❑ Side by Side ❑ Real Estate along Interstate-$175 ❑ Back-to Back Over Under S i L Off Property-$175 Q "V"Type On Building 1 ❑ Service Club Meeting Notice—No Fee Does Not Apply ❑ Religious Meeting Notice—No Fee ❑ Agricultural Test Plot-$175 ❑ Sign on officially designated school bus stop shelter; Affidavit from school officials required-$175 ❑ Directional as defined by sec.TRANS.201.05 Wis.Adm.Code •If box is checked,provide signature to the right-$175 i 1 i ❑ Official(City,Village,Town,County,or State official to be applicant) (Agent Si. .11 t for Directional Attraction or Official) If box is checked,provide signature to the right -No Fee Completed by Wisconsin Department of Transportation r1 • Sign is on WisDOT Project No. , (Approved f Director of Highway Operations) • Cancel existing permit as condition of issuing this permit?( No 0 Yes , If the answer is"Yes",provide permit number and issue date •` R.P.Number Inventory So Inventory .._,..,. of Travel Highway Side Sign Area(Plus border&trim) i zn , . 6. 40 Highway,g isi Direction ❑N ❑s tw E ❑W ❑Left %Right J,'ZOO sq.ft. 660 ft.+from RAN Scenic B ay Check Number Trans.233 Setback issue ate Permit Number I ❑Yes a No ❑Yes No 12 a ❑Yes No 6 Z i /6 2 0 45 ✓ 2 f' d 2?& -`o. 467