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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> American Family Insurance ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6000 American Parkway,Madison,WI,53783 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)242-4100 LeeAnn Glover:LGLOVER @amfam corn ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jason Jones J.H.Findorll and Son Inc. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 300 South Bedford Street 300 South Bedford Street <br /> (City,State,Zip) (City,Stale,Zip) <br /> [' Setbacks <br /> Madison,WI,53703 Madison,WI,53703 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 442-7346 (608) 442-7346 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jjones @findorff.com jjones @findorff.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accesadane,cto.dane.wi.uss1) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 070913410068 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> City of Madison 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 821 East Washington Street, Madison, WI, 53703 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 14,433 2 (public, private) <br /> PROPOSED PROJECT INFORMATION 0 -.; <br /> PROJECT DESCRIPTION: <br /> s <br /> American Family Insurance-The Spark -TOWER CRANE(HEIGHT BELOW IS HEIGHT OF CRANE)-SEE ATTACHED FAA PERMIT a D t <br /> . IS This project is a new building or structure. r erg �' <br /> ertril�t 1Se .. <br /> This project is an addition/alteration to an existing building or structure. ° :; _x' <br /> SANITARY SERVICE: PERMIT NUMBER: cAura1 °!r g <br /> SEWER rEPTIC ( e1N/8XSting } " " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) k x, � r 1* <br /> 224.0 9.0 diWetl'as t loodplair > ".- <br /> "iiShelad (attachment) ;, <br /> AREA TO NEAREST SQUARE FOOT: t0 iTx ,ate <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLOOR.� <br /> L. ErostonControlperrnit <br /> 4, TOTAL SQUARE FOOTAGE: (slop"s,distur lance, <br /> 2ND FLOOR: 3RD FLOOR, filliing/access) <br /> 160,503.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► -► -► and available options. <br /> (Please round to nearest dollar) ,moo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? F.-Yes ✓❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓Yes UNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves ❑No <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) Lyes ❑✓No nDon't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ -+ —► <br /> 545 112 14,081 <br />