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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME / <br /> Qry L • 7 re-rvto ❑ Zoning Stat , UP; <br /> OWNER ADDRESS'(Number,Street,City,State,Zip) Deed R riction;CSM <br /> 7 7 3 5-(-at-� reds. 73 ri ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> qZ©-623 4/z51 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -c-) E L F 5 E 6: Site Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑ Ste PI pproval from <br /> cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /Moor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.tiane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING sal. ACREAGE: Elevation of property <br /> LI PARCEL ER 070/09/i -DyL/_'OJ_� 114 -3 /5 Y 0 4, frontage drawn to scale. <br /> NUMB <br /> TOWNSHIP: SECTION: <br /> ❑ Driv <br /> 0 K C..)171 IA: 5t 1/%: E ate,county, <br /> ADDRESS: ry town) <br /> 7753 sib--W._. RcA 73 <br /> ❑ Sanita mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (p c,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJEC DESCRIPTION: 147.p, A... cLciert;i...„- ,3,_ Co<S. 'beck ,,,- „. -,.....,..,...:. ---,..„4„,„:,..., <br /> a 'aeta <br /> ❑This project is a new building or structure. �r <br /> Er This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: a ; <br />