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SUPPLEMENT to Web•App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Town of Middleton ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) :Deed Restriction; CSM <br /> 7555 W.Old Sauk Rd Verona,Wi 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 833-4346 843-8996 fhankel @town.middleton.wi.us ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Fred Henkel Fred Henkel ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ eptic <br /> 7555 W.Old Sauk Rd 7555 W.Old Sauk Rd <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Verona,Wi 53593 verona,Wi 53593 <br /> PHONE PHONE - Site Plan approval from <br /> 833-4346 833-4346 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> fhankel@town.middleton.wi.us fhankel @town.mddleton.wi.us lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> Q PARCEL 038/0708-174-8503-0 A-1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Middleton '/: '/a'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 10101 Blackhawk Rd <br /> CSM: LOT SUBDIVISION BLOCIULOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION W i rSTAF F REVIIEW <br /> PROJECT DESCRIPTION: 'i r r <br /> 12'x 16'Garden Shed Zoning D( rict <br /> This project is a new building or structure. <br /> 01006411004.10%it i <br /> p 1 9 t4 ertit#0 t sii 504 <br /> This project is an addition/alteration to an existing building or structure. . _ ,, ; <br /> SANITARY SERVICE: PERMIT NUMBER: uralAddres8 ""s r` Fes". <br /> 1EWER 6EPTIC t(new/existing} �'�}" i` . <br /> HEIGHT FEET: NUMBER OF STORIES: (Not Including basement) ' " Jk : <br /> B 12.0 1.0 0 Wetlaf dlFloedplain, <br /> Sho elaritl (axed- e <br /> AREA TO NEAREST SQUARE FOOT: , = s <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ' .m er �. ' <br /> BASEMENT: 1ST FLOOR: U 100A�01W rt�)Relr i <br /> 192.0 4, TOTAL SQUARE FOOTAGE ,, ' (slopes,disturbance r <br /> 2ND FLOOR: 3RD FLOOR flilingfaccess — ,W7 <br /> 192.0 „,, a <br /> Ul Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ i erid available options <br /> (Please round to nearest dollar) $ 3,5500.00 , , r <br /> J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓ao EDon't know <br /> 2. is there a wetland or floodplain on or near the property? ❑Yes no ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property In the past 5 years? Des ✓❑No <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) ❑✓Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> Fre49 $'3 ; APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0.645.112(4108) 'l VAL.-- <br /> U L° <br /> r <br />