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$ 71 , (o0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> '-'sieiTreil j 113 re 66)4- <br /> ADD SS 'Numbe r t;City State / � oning Status;CUP; <br /> a10'j idlt0 PloCn�A r (, � T, �/ 6-3.5--ra. Deed Restriction; CSM <br /> HOME PHONE CELL PHONE U E-MAILA RESS (_/ /. Variance(# ) <br /> eALIS ( `4450/ JeP 1 r i`,r Q rn4 • t P F Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C TRACTOR N IE / <br /> e cohSt-r4c..4-�f1 h 1. ite Plan including location <br /> AGENT ADDRESS CONTRAC ADDRESS of well/septic <br /> Ioa E, ttMc I►1 Si- <br /> (City.State.Zip) ( it Late. pt etbacks <br /> - --- ---- MI, 0 A,ti)) S-3 5511 <br /> PHONE PHONE ' e Plan approval from <br /> ©1P-tar-�37 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> A F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ E - ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE. <br /> PARCEL //-n _ Q��j l _ �^� frontage drawn to scale. <br /> NUMBER L V& 6 c2X2f- L7DCL.: `- — _R.._ -1_,.. D. <br />