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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 /> /alai II-RNESEJV ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> GZS. kJ , S6V-OE ?Z.P j Su.t 107 / r /Sa-` fro .53705 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (o. 'Y9. 9Y3r) ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S-r 'j ,4& toiL1sT CT/014 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> a 6“7-17"/t/406 0 G' <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> /11k1)/ oN t^►/ 5371$ <br /> PHONE PHONE / ❑Site Plan approval from <br /> (p o8 , 2.2_2. i 00 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ' /<v c.4 S4-6vs1n1 6,e)-r1 c'4-e4c4! ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hticp://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: <br /> PARCEL O7 c ?13 116103 <br /> frontage drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> '/4: 1/4'/4: ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> /0/0. E (,.)RSHiAi&R V <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION t 9 rq ' ' „ <br /> PROJECT DESCRIPTION: <br /> AJci& Cg.PNC F 7 .r'4/ T �I,�I(-(f ,,It*,ii—, "',n`' <br /> . ,This project is a new building or structure. it <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: „'` 1,I'-il t''ilet°x4 <br /> EWER SEPTIC ,c"I bYft s a1-y4pi ; b° <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> m;.�i rdr.. �=li•;/ "�/i <br />