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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME (j <br /> CI h,r1S 'r 1,VDNAQ 1 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ? l 3 Sien j zwY\ 1\ ( rY' c_ r r Iq , (-)I S-. S.'S-3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -33g(0` S-D ( .L 38-7 I 4 3 a k(a rl C))Shm q,I. /l ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S k 4/,✓ic i 4,1cl pAs ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 17z Sky brie Ar• <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> t c _ R-73 - )3c.3 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> d ct w ha yh n‘e4/Z:-)3 yed 1160,C__0)y,,.‘ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER o 2 3/bID v 9 320 b g 14 1 —2-- <br /> frontage drawn to scale. <br /> TOWNWP: SECTION: <br /> Lunn a - 1/4: n (3 %IA: S ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> S q m t'_ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> i <br />