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ZONING PERIUIrT APPUCA11ON www countyamaneoom . . <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME /� �� / <br /> �g� /aC �t� /1) ` / �ning Status; CUP; <br /> OWNERADDRESSumber,Street,City,State,Zip) i Deed Restriction; CSM <br /> 2271�D rl!e .40.40I-1.6.2 GtJL 5�5�•� Variance(# ) <br /> HOME PHONE CELL PHONE E- AILAD RESS <br /> loo''x/23-3/9� X08 22<23fq /(Sae 4//611eridi F)6/2°f I:Eite Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6 /i',6 ils7'/-1 I74� uC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3114./ -.kY kiif4 kd. <br /> (City,State,Zip) (Ci State,Zip) ❑Setbacks <br /> � /74 ye Gt14e /,u1. 53.al <br /> PHONE PHONE ❑Site Plan approval from <br /> O 8- 83/-586‘; applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El PARCEL Z4,12222410066? "/ frontage drawn to scale. <br /> NUMBER <br /> TOWNSH)IP. t ', �,�/ SECTION: <br /> elikl5774- 2�c miok tlA y,: '/4'/e: Driveway permits <br /> state,county,town) <br /> ADDR�214. w 73( C drni h 4 n. cc, <br /> ElSanitary permits , v Wkv CSM: LOT SUBDIVISION BLOCK/LOT (public,private) , U, <br /> C. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: f , <br /> i <br />