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Application Fee: <br /> Dane County <br /> -0 �'it r.p& Department of Planning and Development sls <br /> V:.. _ • ZoningDivision <br /> PERMIT FEES DOUBSSE K HAS STARTED PRIOR TO <br /> Room 116,City-County Building ISSUANCE OF OF PERmIIY <br /> p 210 Martin Luther King Jr.Blvd. <br /> 219-MS Madison,Wisconsin 53703 <br /> (608)266-4266 <br /> DOMESTIC FOWL ZONING PERMIT APPLICATION <br /> Property Owner Name: Abigail Gaspari Phones 936-647-5505 <br /> Mailing Address: 318 Maple Heights Rd.Marshall,Wi 53559 <br /> Email Address: Gaspariabigail Ogmail.com <br /> Agent Name: Phones <br /> Mailing Address: <br /> Email Address: <br /> SITE INFORMATION <br /> Prolect Description: Please provide a brief description of the project. <br /> 6x8 sqft chicken moveable coop/ <br /> run <br /> Area(square feed: tieSa(feet): - <br /> 45 sq ft Oft <br /> Site Address: Town of: <br /> Medina <br /> Zoning District: Distance to Neighbor's Residence(feet): <br /> SFR-O8 Neighbor 1:100 X Neighbor 2:200 X <br /> Check Applicable: 0 Shoreland 0 Floodplain 0 Wetlands <br /> IP' 0812-111-6316-2 <br /> GENERAL APPLICATION REQUIREMENT <br /> O Site Plan Drawn to Scale 0 Elmtlan Drawing oning Permit fee of 815,cash or cheek made payable to Dane County Zoning <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to <br /> the accuracy of that information.I further certify I am the property owner,or a duly authorized representative,and may sign this <br /> permit application on behalf of the owner(s)of said property,and I have read and understand all of the conditions of this permit <br /> and will construct the protect in compliance with those conditions.I understand that failure to provide accurate information or to <br /> comply with any provisions of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department <br /> of Planning&Development to determine compliance with the county's zoning ordinances.This consent is valid for the period <br /> commencing with issuance of this zoning permit and terminating with issuance of a certificate of compliance or until earlier <br /> revoked in writing by the owner of the property. <br /> PRINT:Owner/Agent DATE: <br /> Abigail Gasp ' April 2,2021 <br /> SIGNATURE:Owner/ ������ <br />