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LL SUPPLEMENT to Web-App # <br /> ZONIN P�T'APLICATION wvvvv.countyoffene.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Shachar Peles ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3637 Welcome Drive,Verona WI 53593 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (414)324-3780 (414)324-3780 speles81 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> none none(building the deck myself ❑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/) ❑ Elevation of property <br /> ❑PARENT NUMBER PARCt7UMBF1$: 3O 1 C0 ZONING: ACREAGE: <br /> PARCEL O G ... ...681 .- ( 1.00 $7� frontage drawn to scale. <br /> TOWNSHIP. SECTION: <br /> Town of Middelton '/4: '/4%: ❑ Driveway permits <br /> (state, county,town) <br /> ADDRESS: <br /> Cl7 VO C Des <br /> CSM: LOT SUB 9I SION B 0 K/LOT ❑Sanitary permits <br /> ..ter WO ' , • i <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> deck and 3 season room at the back of the house ❑ Zoning District <br /> EThis project is a new building or structure. ❑ Permitted Use? <br /> MI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: A �+ ❑ Rural Address <br /> FIEWER JEPTIC 201 x400,706 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10.0 2.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ Erosion Control permit <br /> BASEMENT: 0.0 1ST FLOOR: 365.0 <br /> 4, TOTAL SQUARE FOOTAGE: ,l. (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: J ♦ filling/access) <br /> 365.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 1 0,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes E No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ❑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 ONo ODon't know <br /> 7. Is this to correct a violation? ['Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - <br /> 545-112(4/08) <br />