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0\/.\(\c- -ii■ tk*I-k —oeidi <br /> ZONING PERMIT APPLICATION www. ountyofd e.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Andrew J. Stokes El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 505 Pine Tree Rd.Kohler WI 53044 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (920)226-7932 (920)226-7932 ajstokes@hotmail,com <br /> Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i-- _ []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: ❑Elevation of property <br /> Q PARCEL MBER 090621497007 A-1 EX 38.00 frontage drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> Mazomanie 21 to SE +%+4. SE El Driveway permits <br /> ADDRESS: (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 '71,::':+'--' ' <br /> PROJECT DESCRIPTION: ,. <br /> Agricultural Maintenance building/Sa�raana eebfrr 0 , fining Dish <br /> This project is a new building or structure. <br /> 0 Permitted Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 RuralAddress <br /> E EWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET: �� NUMBER OF STORIES: (Not induding basement) <br /> 12'6" 1.0 0 Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shcxelarid (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U fOSionC©ntrol permit <br /> BASEMENT <br /> 1 ST FLOOR: 432.0 1 TOTAL SQUARE FOOTAGE: 4 (#topes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filting/access) <br /> 432.0 <br /> O Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► -► -�► ♦ ndavailable 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 QNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [DYes No QDon't know <br /> Q <br /> 3. Have you talked with the township about your project and are they in agreement? Yes UNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes '4No <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) QYes jlo ['Don't know <br /> 7. Is this to correct a violation? Eyes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -+ -♦ <br />