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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 /> Town of Middleton Zoning Status; CUP; <br /> OWNERADDRESS (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.wl.us ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Fred Hankel Fred Hankel 0 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.wl.us fhankel @town.middieton.wl.us IoOr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> Igl PARCEL 038/0708-174.8503.0 A-1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Middleton 1/4: 1/41/4: ['Driveway permits <br /> ADDRESS: (state,county,town) <br /> 10101 Blackhawk Rd <br /> CSM: LOT SUBDIVISION BLOCKlLOT 0 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ., STAFF:REVIEW , . <br /> PROJECT DESCRIPTION: 'x `. . . t i:£ <br /> 12'x 16'Garden Shed �lj oning District � �. <br /> II This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. i- a tf q k r , <br /> SANITARY SERVICE: PERMIT NUMBER: iii ddr 65 ' ' er ,ft <br /> ftrr �'" <br /> EWER i£PTIC � '�ii� �5 � � . <br /> HEIGHT I FEET: 'NUMBER OF STORIES: (Not Including basement) A s� ' i- fp: �s ri. <br /> ,�� Pj 12.0 1.0 O AletlaridlFloodplaln/ �;, <br /> # horeland 4(attact it enJ } <br /> AREA TO NEAREST SQUARE FOOT: 3 � � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) K ,3 `` � <br /> BASEMENT: 1ST FLOOR: C troy on o i l r li , <br /> 192.0 ,l, TOTAL SQUARE FOOTAGE: 4, tSJt j W*turbance <br /> 2ND FLOOR: 3RD FLOOR: : llinglaacess { <br /> 192.0 x -,-� <br /> D Rev1ew Location Survey <br /> ESTIMATED CONSTRUCTION COST: `- a lid a'�i7ailabt4 op(t--,..;44.-s <br /> (Please round to nearest dollar) ♦ —i ♦ "� "1, -4 $ 3,500.00 4'°A -.._�.__ .:, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des —✓[ No ]Don't know <br /> 2. Is there a wetland or floodplain on or near the property? []Yes ✓ o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes al <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) 0✓Yes alo ❑Don't know <br /> 7. Is this to correct a violation? : Yes 1/['No <br /> Fr P S 3 3--sw--1 APPLICATION MUST BE SIGNED <br /> 645-112(4106) N, 0 Q ,e VicA) (Continue on Back) —► —► <br />