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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER I ME <br /> 6 �I�� _ V) <br /> /64 V ,�/�J./Q`,V` {4/wL WI ❑Zoning Status;CUP; <br /> OWNER AD RESS (Number, eet,City,State,Zip> Deed Restriction;CSM <br /> 73j4. v / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ` <br /> 0 Q ! /., S a""...2 Pg5 A ■ i 2 i' I fl44,4 L'Lbw , ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks 't-\ '\l <br /> PHONE PHONE El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> NA .t oti y '/a: Y4/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9 7-3 jr ak WV, . ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT CRIPTION: <br /> j yco,NS ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address ► / <br /> DEVER FIEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> DANE COUNTY ZONING PERMIT DCPZP 2016700504 Page 1 oft <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> ROBIN H MAROHN (608)220-7500 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 201 ISLAND DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53705 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ppenn0402 @gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0606-363-8625-0 TOWN OF BLUE MOUNDS 36 SW NW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 9736 BLUE VALLEY RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 2 CSM 13606 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> A-B Ag-Business I 14.413 (Description:restroom addn 1 328-Other Non-Residential <br /> flictrirt <br />