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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 /> Bob Patel <br /> ® Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City.State.Zip) <br /> 6900 Seybold Road,Madison,WI 53719 Variance Restriction; CSM <br /> Varriaia nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)718-0700 bpatel73 @hotmail.com is Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Chris Cronin JNB Signs, Inc. fl Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1221 Venture Drive 1221 Venture Drive <br /> (City,State,Zip) (City.State,Zip) 0 Setbacks <br /> Janesville,WI 53546 Janesville,WI 53546 . <br /> PHONE PHONE ❑ Site Plan approval from <br /> (608) 754-6338 (608) 754-6338 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ccronin @jnbsigns.com ccronin @jnbsigns.com (-I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) a Elevation of property <br /> 0 PARENT PARCEL NUMBER: �[�'(f�, CURRENT ZONING: ] ACRE E: <br /> NUMBER C 7 C'8. �• )-t-1w ^ 1 �� frontage drawn to scale. <br /> TOWNSHIP: SECTIO t <br /> Middleton - ;) 1/4. . "y^ / 1/41/4: ;/'�,i J _ Driveway permits <br /> ADDRESS: (state, county,./own) <br /> 6900 Seybold Road -' <br /> cs,M: LOT SUBDIVISION BLOCK/LOT n Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: r <br /> Remove existing pylon sign to grade, install new pylon with 45 ft. OAH Li Zoning District <br /> . 12 This project is a new building or structure. 0 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LJ Rural Address <br /> [EWER nEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 45.0 ❑ Wetland/Floodplain/ <br /> Shoreland (ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: F-1 Erosion Control permit <br /> 1, TOTAL SQUARE FOOTAGE: ,,, (slopes,disturbance, , <br /> 2ND FLOOR: 3RD FLOOR: f Iltng/ACCESS) <br /> ❑ Review Location Survey '' <br /> ESTIMATED CONSTRUCTION COST: $ 30,000.00 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? EYes F./]No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ENo EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes QNo <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) EYes nNo QDon't know <br /> 7. Is this to correct a violation? EYes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i —► <br /> 545-112(4/C8) <br />