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ZONING PERMIT APPLICATION SUPPLEMENT to Web-App# <br /> www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 'G 0(Z y J. T'// A. 1//4 1.4 <br /> /1,Z S O, ■,' oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> / / d2 /7 ./V / 2_ */ C Deed Restriction; CSM <br /> \/ HOME PHONE CELL PHONE D E-MAIL ADDRESS Variance (# ) <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Ite Plan drawn to scale <br /> AGENT NAME CONTRACTOR NAME and includes dimensions <br /> X 22 y •2/L�i 'G. trice -1.'/C.., <br /> AGENT ADDRESS CONTRACTOR ADDRESS 1..t Plan including location <br /> _Anco2 6/2i-Cc= 69(../ of well/septic <br /> (City,State,Zip) (City State,Zip)4972,2,5/l(h <br /> LS 53 etbacks <br /> PHONE PHONE <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> G Ite pproval from <br /> 72/� S) �6,22c4,L , c crn- applicab wnship. <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: plans to <br /> scal /B PARCEL <br /> NUMBER °')/2332g5-10/ 8 A - / :-X 3 S <br /> P 1/s ,o c Elevation of property <br /> TOWNSHIP: SECTION: 33 1/4: (V(1/ <br /> frontag drawn to scale. U <br /> tr ADDRESS: Driveway mits <br /> 10 a% -JS I-4 t -4/" (state, c nty, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> USanit.r •ermits <br /> (p . private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /MCI -7/d N 0(C � D/v; -' Wp p r 2 C/ k 3 z Wing District <br /> UThis project is a new building or structure. L��� / <br /> L1lBefmitted Use? <br /> 1This project is an addition/alteration to an existing building or structure. <br /> `SANITARY SERVICE: PERMIT NUMBER: URural Address <br /> EWER #EPTIC (new/e 4/1111b.\ U <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) Wetl FI0 In/ <br /> l 0••Shorelan achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: UEro- onCo rol permit <br /> / / (slop:. •isturbance, <br /> 4— /S3 filli : a. ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> UReview oc,. ion Survey and <br /> ESTIMATED CONSTRUCTION <br /> COST: 1 1 1 1 1 1 � availa. - options. <br /> (Please round to nearest dollar) C; 00000 ` 0 <br />