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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Frank & Dana Seltzner ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4 SAVANNAH PKWY ,Deforest Wi 53532 Variance(# ) <br /> to-ME PHONE /CE L ONE -MAIL ADDRESS <br /> 'jg /�,2) • 1 f i 4 choiceconcrete @yahoo.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeanette Acker Premier Builders,Inc. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Waunakee WI 53597 Waunakee WI 53597 <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> (608) 849-6770 (608) 849-6770 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeanette.acker @tds.net jeanette.acker @tds.net ❑Floor plans to scale <br /> e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: <br /> NUMBER RC 0812-073-8850-0 P I--Z el.S^:St"--Z frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Medina 7 1/, nw %OA. sw ['Driveway permits <br /> ADDRESS: <br /> (state, county,town) <br /> t s k �l5 �w� <br /> CSM :LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 10,993 2 (public,private) <br /> PROPOSED PROJECT INFORMATION 1 1j " <br /> PROJECT DESCRIPTION: i/i/� <br /> ��ir <br /> New Home Construction �� <br /> . 0 This project is a new building or structure. /a ,w1,, 4/ <br /> ❑This project is an addition/alteration to an existing building or structure. � % "" % <br /> SANITARY SERVICE: PERMIT NUMBER: Ci?,1/11#APAIOS <br /> 9 has '''' <br /> EWEREPTIC <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ''; ' <br /> 26.0 <br /> 1.0 � <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) " <br /> BASEMENT: p 1ST FLOOR: s <br /> 2,258.0 3,711 .0 ' 4, TOTAL SQUARE FOOTAGE: 4, „'� i , <br /> . 8 tEg r 8.. !," <br /> 2ND FLOOR: 3RD FLOOR: <br /> i. <br /> 5,969.0 ?'",% <br /> o <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ 298,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes riNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes EINo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? res ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves 1/I 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 ENo NIDon't know <br /> 7. Is this to correct a violation? Elves JNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) - -. <br />