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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 /> David Casimir 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 11566 Midtown Rd.Verona, WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 845-9344 dacasimir @casimirjones.com El Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Chad Gebhardt Gehin Custom Homes ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3245 Mound View Rd. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona, WI 53593 W3238 Daytonwood Rd. <br /> PHONE ❑(608) 957-1594 PHONE (608) 576-9536 applicable ownship . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> cagd @sbcglobal.net nbttgehin @aol.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> ❑PARCEL 0708-314-9690-0 G4 G7 9.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> TO7NRO8E Town of Middleton 31 1/,: SE a the SE y-1/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3245 Mound View Rd. Verona WI Sanitary permits <br /> CSM: j LOT SUBDIVISION BLOCK/LOT <br /> 8,480/08, ,10 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Utility Garage ❑ Zoning District <br /> . 0 This project is a new building or structure. ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER )EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 12.5 1.o CI Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ rOSlOrtControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 416.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 416.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ –+ ♦ ♦ ♦ ♦ $ 7,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El/es ]No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes No DDon'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? Dies EiNo <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) El'Yes Do DDon't know <br /> 7. Is this to correct a violation? QYes ✓I10 <br /> APPLICATION MUST BE SIGNED <br /> sits-ttz(4/08) (Continue on Back) -+ - -♦ <br />