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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 /> Ambiance Homes Inc <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 4 toeing Status;CUP; <br /> VVVV 5838 Grassland Terrace Marshall,WI 53559 d Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)225-4594 ambiancehomesinc @charter.net - - an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc 0 Site Plan incl • location <br /> AGENT ADDRESS CONTRACTOR ADDRESS O S C <br /> 5838 Grassland Terrace 5838 Grassland Terrace <br /> City,State,Zip) (City,State,Zip) 1 •a s _/,J <br /> Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE PHONE Q Site Ian proval from <br /> (608) 225-4594 (608) 225-4594 appli etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @ charter.net ambiancehomesinc @ charter.net 0 Fl.• •Ian to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El- -tio of property <br /> ElPARCEL 012/0911-193-0067-0 A-1 0.77 'ontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> i - Bristol 19 1A: NE IRA: SW IN Driveway per- <br /> (state,count town <br /> ADDRESS: <br /> 3oq?r Parker Pass <br /> Igi Sanitary permits LIE <br /> CSM: LOT 7 SUBDIVISION BLOCK/LOT (public,private) l �Q <br /> Parker's Place <br /> PROPOSED PROJECT INFORMATION l'AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential \✓/Sc/1tt r QOf� w Gal'Z ikG Oning District <br /> . NI This project is a new building or structure. ermitted Use? <br /> EThis project is an addition/alteration to an existing building or structure. ( � <br /> SANITARY SERVICE: PERMIT`NUMBER: `�' I Address <br /> �� <br /> FIEWER {EPTIC `�j��t Lk_ ��r�'l 441:4;x 1 sti n g) <br /> `� HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Z-2-- 1.0 121 We /F plain/ <br /> hor attachment) <br /> ARE%/).-.:16,a'S <br /> NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) C trot permit <br /> ❑ Eros : <br /> BASEMENT: 1ST FLOOR:. <br /> 1 1 � 4, (slope ,ist rbance, <br /> 1J TOTAL SQUARE FOOTAGE: j (sl0 p <br /> filling,acce s) <br /> 2ND FLOOR: 3RD FLOOR: (� <br /> 0.0 C -eview Lo ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -�♦ ♦ ♦ and ava' le options. <br /> ♦ <br /> (Please round to nearest dollar) $ 240,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EiYes ✓❑No QD t know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ✓ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ✓}lo <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) l Yes ao DDon't know <br /> 7. Is this to correct a violation? QYes ✓❑ 10 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ -+ <br /> 545-112(4/08) <br />