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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 /> 14 w( t i lam, d la vi: e V 1 fir••°!1.J Cc---/(. ( ) D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip) <br /> r a � / r.� . � Deed Restriction; CSM <br /> 0)61/x. C 1 r ',t'r t i" 1 , G',6-r,,1 i, //O.= W-. i Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /i#-'?/`7. ', 14:r'' 7Gt-.r t,,4'"" r li. 7.. t'. `'7 ' 541.;, -' r-..?e', `..f" ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFOIEJIATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> PW.i,ii`H, �.. , ' 1 .L 6I4 ,L ';_t _: ,, - . Site Plan including location <br /> AT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> :.fit (1 :,S't r"fit",-,, <br /> (City,State,Zip) (City,State,Zip) [ etbacks <br /> CCU' <br /> PHONE PHONE L]Site Plan approval from <br /> :: _ <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS /•,7 <br /> I J 1 t ` ts, 'ki4 S, CO A [j F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> D NUMBER Ou i D ( -)3o i �" / ' / ' ,w'� `- frontage drawn to scale. <br /> TOWNSHIP: SECTjN: <br /> tai i- 1/4'/4:T6lj Driveway permits <br /> I �, �•� y 1 /� /4' (state,county,town) <br /> ADDRESS: /4/ C <br /> 2C(/ ? <br />