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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 /> I) ./0 /0 IS 3-% H ILGC M.b0 R1 ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stale,Zip) Deed Restriction;CSM <br /> 5S- W/ -S f-f (AJ G'T`OA) ROA-n Variance(# ) <br /> HOME PHONE CELL PHONE E•MAILADDRESS b1.4/1._.6 eN ao p-.,r-E <br /> 2-79 --I6 SS 27 q —(/5S cs Pi N COP pop rte, cDF-I ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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.Slate.Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> n e EtiIWiL�7iDRFtF _ s <br /> ... ._._._ ...__ _.:_ _. .:= __._ _ :..: ❑FiiSoans.fo"scare` ....__ <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation ofproperty <br /> ❑PARCEL O( ``. 3 I if_ i 41..3 'Ark frontage drawn to scale. <br /> NUMBER �VV Y r f/ r l►o <br /> TOWNSHIP: SECTION: <br /> I f f;' 1A 1/%. ❑Driveway permits <br /> /6s-s_ frPcs "5ir✓' <br /> 1-0 k Z C.SAl 35' t 337-g (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> - STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> G H- ( G(4. -k) COO p j 1 x 11 D Zoning Distnct <br /> . EfThis project is a new building or structure. _O=Perrrtitfed_U5e?:–. i-.____; <br /> ['This project is an addition/alteration to an existing building or structure. =— - _ _ - <br />