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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C)STOMER TO PROVIDE <br /> OWNER NAME �[ 1 <br /> D,blD 1 e. T l0 l\ber ri 4Cning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) peed Restriction; CSM <br /> 84 e 1"r4i 1 V I Pd 1/-e(br, w'1 5Q3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> A,- 5-117 ••i-770- • • Kolb' 4 Ivaco [Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ' any-includes dimensions <br /> AGENT NAME CONTRACTOR NAME r <br /> . el -patio QYYIe ■A- l b Des f(1 1 brne El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES fof well/septic <br /> Lb-1D R. &A ram Pd. 1-Ib70 - - 1365har✓1 Pd- i <br /> (94., fate,Zip) (Ci State,Zip) Et Setbacks <br /> due 1401111S11.01 X17 `clue I1 ends, 1 .31 X517 '� <br /> PHONE I PHONE Et'Site Plan royal from <br /> Coaa -L437- &l S 1 L008- 14,37 - Loa 13 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ica • • deve\ rienk-. 'cc �.develc n(-C,�m ]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 /> ❑PARCEL 0 07 w oa -c151D-# /\ - 1 e .Qn-7 frontage drawn to scale. <br /> NUMBER vl�/V lbL1 V 1� ''i / <br /> TOWNSHIP: SECTION: <br /> Sr.( 1� 1 1 N 1/41/4: 0 ? Driveway permits <br /> ; i( 3 A \ka YYt. W( 5 .5q 3 i'atreortv p county, <br /> -ex 1s+ino6 <br /> CSM: LOl"- SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> (public, private) <br /> 1 Co5� r <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: as <br /> ?ID Skne■)e, -00,nrci It r-esid2nce <br /> . his project is a new building or structure. ' , <br /> This project is an addition/alteration to an existing building or structure. '-: <br />