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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 /> Reggie Lund ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 2777 Marshall Pkwy Variance(# '3 67 S ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)345-0512 reggielund@gmail.com ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) '(City,State,Zip) etbacks <br /> PHONE PHONE Site PI pp oval from <br /> appli ab a wnship. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0-Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0709-273-6952-6 R_2C.421'1 0.24 frontage drawn to scale. <br /> NUMBER S <br /> TOWNSHIP SECTION <br /> Town of Madison 27 "/4. 1/4. ❑ y Efirive e Its <br /> ADDRESS (state tkrty, town) <br /> 2777 Marshall Pkwy <br /> ElCSM: LOT 2 SUBDIVISION BLOCK/LOT Sani ry r Its <br /> Saywer Additioin Lot 2 (p lic, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Garage Addition Zoning District <br /> I . <br /> This project is a new building or structure. <br /> Er Permitted Use? <br /> ❑✓ This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: aRuraykddress <br /> EWER [EPTIC (newisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES. (Not including basement) <br /> Z(Wetlectlobdplain/ <br /> i Shreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> LJ ErosionC9p0Oermit <br /> BASEMENT. 1ST FLOOR ,-,,- <br /> >�` 4, TOTAL SQUARE FOOTAGE: 4. (slopes,dlstu ante, <br /> filling/access) <br /> 2ND FLOOR 3RD FLOOR: <br /> 0.0 <br /> Li—Review Loc n�e <br /> ESTIMATED CONSTRUCTION COST and available ptTOf1S <br /> (Please round to nearest dollar) "♦ ♦ ♦ -► ♦ ♦ $ 61 1 % l _�( ((` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ❑No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑✓ Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes 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) Dies ❑No ['Don't know <br /> 7. Is this to correct a violation? Dies ❑✓ No <br /> It Z''' O APPLICATION MUST BE SIGNED <br /> \b (Continue on Back) <br /> REV(01/19) <br />