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<br /> ZONING PERMIT APPLICATION www.countyofdane.com u4U L'EMENT#o 11Veti Ap#:
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<br /> OWNER NAME I CUSTOMER TO PROVIDE
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<br /> OWNER ADDRESS(Number,Street,City,State,Zp) qq Deed Restriction'CSM
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<br /> HOME PHONE CELL PHONE E-MAILADDRESS •
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<br /> • ❑Site Plan drawn to scale . 1
<br /> AGENTINFORMATION �CONTRAC OI INFORMATION in.=. _ Gsr• - and includes dimen•�
<br /> 'AG NAME CO �`CTOR NAME T `- 0,0 r t L/N
<br /> I S 4_ (0/( • t'79.1.�;« CO �� - ❑Site Plan including Iscation
<br /> AGENT ADDRESS CONTRACTOR ACADRESS of well/septic
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<br /> E-MAIL ADDRESS E-MAILADDRESS ti mil; 4,,,..4...44.,, ❑Floor plans to scale
<br /> PROPERTY/LOCATION INFORM ATION htt !/accessdane co dame wi us "`W%
<br /> PARENT PARCEL rrUMBER CURRENT ZONING: ACREAGE . ❑Elevation of property a&•.
<br /> ©NUMBER O e/O .-_ S3-4351 0 - Zv7 —`��;ip'�' , frontage drawn to scale.
<br /> TOWVNSHIP: i / SECTION: _
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<br /> ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT Q
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<br /> PROPOSED PROJE_CT INFORMATION . _ `.. x ;'y f-"-'
<br /> PROJECT DESCRIPTION _ ;� r.r�i. z
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<br /> This project is a new building or structure. -ft-1-- '` 4 =��
<br /> ❑This project is an addition/alteration to an existing buildin r structure: i 4 ,
<br /> SANITARY SERVICE PERMIT NUMBER:� ' ,/ „.....:,r,,.„..„..,,,• ss -,
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<br /> HEIGHT IN FEET `A , NUMBER OF STORIES: (Not including basement) y ' �'
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<br /> AREA TO NEARS T SQUARE FOOT: W, :
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