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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O EER NAME , <br /> E0 RAF e. -kJ 7v.1 'co— tu(L is !mil <br /> ❑Zoning Status; CUP; <br /> O R ADDRESS (Number,Street,City,State.Zip) Deed Restriction; CSM <br /> 3 7 S 8 r a,_o N r3ci� (- 8 S u P,e�r, r.P LL1Z S 3 9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> b tc g 2,(>7 ibbtsQ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME , CONTRACTOR NAME <br /> Cie or9 e E Cyr , Q �l J/j4 t/00Ka.,,2 i s -4a f LLC❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �/ /} of well/septic <br /> 2373 C2Uiki72, /`T Q <br /> (City,State.Zip) (City,State,Zi ) ❑Setbacks <br /> N'lc .v/o G�/rS3S5$ <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6 o T-7 7 g- 6 a // applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS / - <br /> l "ri-,e r i'f _ Cl�.C-e1 , ,ve 71. 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑Elevation of property <br /> PARENT PARCEL NUMBER CURRENT ZONING:(http://accessdane.co.daAnceR.EwAGLEus/) <br /> PARCEL °f t_ a _zy/_ 2 yy 2 Le s s fi�aN frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ^r <br /> 8 crl Z1( '/a: ./v L wiii: L I=1 permits <br /> ADDRESS (state,county,town) <br /> ,�3� rQ N /2c/41 g—J Su / P�fi r'.e A-LL 53,6-'6 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Z GA—r— Ael-! (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: t om C d EN s fr� g' PA o <br /> . EiChis project is a new building or structure. <br /> Y _, ' <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: Ai PERMIT NUMBER: A <br /> EWER r)EPTIC ° - <br /> HEIGHT IN FEET: NUMBER OF STORIES- (Not including basement) s <br /> AREA TO NEAREST SQUARE FOOT: ' ,% '- " <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �` s <br /> BASEMENT 1ST FLO <br />