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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 /> Copt l Gk i,. -,V:,; e.`r e?..,r. t :- , <br /> OWNER ADDRESS (Number,Street,City,Slate,Zip) ❑Zoning Status;CUP; <br /> 33c3 I K y %t-^A•^-y .%L-Jr1 ' lr, �1 S3-2o4 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ' Variance(# ) <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONK ACTOR NAME <br /> �►.zr 1'ut/ 15 <br /> / ro—r44. []Site Plan including location <br /> AGENT ADDRESS C N RACT09,ADDRESS of well/septic <br /> (City,State,Zip) (CityAtate,Zip) _ <br /> pi/174, , -�,� ❑Setbacks <br /> PHONE PHONE <br /> Co G ,�/ ' �/ Site Plan approval from <br /> 0 _s (—; 7/( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 7&a.rM"Mc.i°.N e4-aer/a,i i 44 (v,:,[Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi,usn <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: [Elevation of property <br /> 0 PARCEL <br /> NUMBER ZS 013 10 I L. Gi0.,17 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> C 1- , 0• 5' SAN +/4. %%: [Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3L(07_ IC t,..,SiNntio-, 7;%,-. c.1 t4. <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 1251 (40 1 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> a ,gill Eirt. : <br /> PROJECT DESCRIPTIOJ Cr,/ / / <br /> "Je f11/20 f i? ( 7 e. — �b O c77exvi c-•1 ❑ dro.Dis f tt <br /> • ❑This project is a new building or structure. �,, �. <br /> CI Permitted.. . , . <br /> ['This project is an addition/alteration to an existing building or structure. 149. <br /> SANITARY SERVICE. PERMIT NUMBER. U Rural'Address <br /> EWER [EPTIC (neW/existing) _, <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) " " <br /> ❑ Wetl'and/FlQadpf6ini, <br /> ��� Shoreland (attachment <br /> AREA TO NEAREST SQUARE FOOT: . ) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . <br /> BASEMENT: 1ST FLOOR: Q ErQSIQnCb�itCq(peimlt <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbancey: <br />