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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Andrew J. Stokes ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 505 Pine Tree Rd.Kohler WI 53044 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - Variance(# ) <br /> (920)226-7932 (920)226-7932 ajstakes @hotmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE --- PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p Elevation of property <br /> o NPARCEL BER 090621497007 A-1EX 38.00 frontage drawn to scale. <br /> UM <br /> TOWNSHIP: SECTION: <br /> Mazomanie 21 1/4: SE W/41/4: SE El Driveway permits <br /> ADDRESS: 1 - (state,county,town) <br /> East of 10436 Law's Dr. Mazomanie WI 53560 <br /> CSM: --- LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> '' STAFF REVIEYII <br /> PROJECT DESCRIPTION: <br /> Agricultural Maintenance building/Seasonal cabin CI Zoning District.. <br /> . ['This project is a new building or structure. <br /> (3 Permitted Use? <br /> 19 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> EWER DEPTIC (newlexisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 12'6" 1.0 0.,AetlaldI 'ioodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> © ErosionControl;permit <br /> BASEMENT: 1ST FLOOR: 432.0 1 •TOTALSQUAREFOOTAGE: j (slopets,;disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fflllrtg/aCCess) <br /> �— 432.0 p Review;Location Survey <br /> I ESTIMATED CONSTRUCTION COST: _o _ and available options. <br /> (Please round to nearest dollar) $ 1,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes DNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓ Yes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes lIgNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Oyes No ['Don't know <br /> 7. Is this to correct a violation? QYes I.:No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />