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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION •° ,'.,- ._, .,-„ <br /> OWNER NAME <br /> Zimbrick, Inc <br /> in tus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 1601 W Bernina Highway,Madison WI 53713 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)230.0100 (608)219-1611 kdahmenCialmbridc.com an drawn to scale ':,l <br /> _[H4ZIMIatstal',r_ lt•1: rrn_T•lit•l:111:11•]:14Ili[0: and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Kathryne IGppes La Crosse Sign Group-Kathryne Kippes W.Site.Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of weilisoptia., <br /> 2242 Mustang Way 2242 Mustang Way m . <br /> iii ---,„(City.State,Zip) (City,State,Zip) �A1LI -,•- S <br /> Madison WI 53718 Madison WI 53718 <br /> PHONE PHONE A Si - Ian approval <br /> (812) 841-2742 (812) 841-2742 •plicable tnship.om <br /> E-{:1AILADDRESS E-MAIL ADDRESS <br /> kathryne.kippes©lacrossesign.corn kathryne.kippes©lacrossesign.com d Floor •t, to Sc to :i <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: <br /> CU/ � NING: AC BE4 G E: 7010*-"non o#p ro rty <br /> ❑ AMCBEEL R �'n a A11`'f�3`t / . 9 = .frontage dral . scale. <br /> le. <br /> TOWNSHIP: SE () <br /> %1N <br /> of Madison +/a: +/a+/a: Dr' a rmits <br /> ADDRESS: ( - ", • nty,town) <br /> 1601 W Beitline Hwy Madison WI 53713 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El San'r_ rmits <br /> AIL (pu,l'•, ,rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Replace existing Buick GMC signage on entry tower and clock towers. ning District <br /> ❑This project is a new building or structure. <br /> rmitted Use? <br /> o This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB ❑ Rural 1 .. • -- <br /> ( EWER f EPTIC �-IA (new a istin. <br /> HEIGHT IN FEET: NUMBER OF STORIE :Ant including basement) <br /> �j/�p ❑ -nd/Floodplain/ <br /> i'\-/ •reland (attachment) <br /> AREA TO NEAREST SQUARE FO T: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ • 1• Control permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (sic,.-s, •isturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> fill' g/=«.:A ) <br /> ❑ Re ' ocation Survey <br /> ESTIMATED CONSTRUCTION COST: -110 -• able options. <br /> (Please round to nearest dollar) --• $ "\\,1.0 E___ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes DNo + JOon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes Do <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes DNo <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) Dyes JVo DDon't know <br /> 7. Is this to correct a violation? Dyes Llo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -4. -1. <br />