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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE q <br /> OWNER NAME <br /> Ambiance Homes Inc 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM ■ <br /> 5838 Grassland Terrace Marshall,WI 53559 Variance(# ) ©?/ <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)225-4594 ambiancehomesinc @charter.net 12 Site Plan drawn to scale , l <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions , <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc OSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of AidinegliW- <br /> 5838 Grassland Terrace 5838 Grassland Terrace 2 � �/�C <br /> (City,State,Zip) El Setbacks 7 f <br /> (City,State,Zip) � <br /> Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE 51 Site Plan approval from r t ii, <br /> PHONE (608) 225-4594 (608) 225-4594 applicable township. �j <br /> E-MAIL ADDRESS E-MAIL ADDRESS 0 Floor plans to scale <br /> ambiancehomesinc @charter.net ambiancehomesinc @charter.net <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usl) 0 Elevation of property 4- <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation <br /> drawn property ryale. y6 <br /> 0 PARCEL 068/0910-293-6397-0 R-4 DCPREZ-0000-09079 0.43 <br /> NUMBER <br /> TOWNSHIP: SECTION: NI Driveway permits, <br /> ���---fff Windsor 29 '�a: SE '�a'�a: SW ( town) <br /> ADDRESS: /slid <br /> > Scenic View Road ea Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, <br /> 37 Prairie Creek <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW / <br /> PROJECT DESCRIPTION: /T Zoning District /y <br /> Single Family Residential c°?7 <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. �y(R I Address �3ED <br /> SANITARY SERVICE: PERMIT NUMBER: Fp/existing) <br /> EWER �EPTIC C/ > 30 o <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Wetland/FIOOdplain/ <br /> 23.0 1 Shoreland (attachment)z I 000 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit A <br /> BASEMENT: 1ST FLOOR: 2,980.0 r <br /> TOTAL SQUARE FOOTAGE: j slopes,disturbance, / <br /> 1 ,844.0 filling/access) PP <br /> 2ND FLOOR: 3RD FLOOR: 0.0 4,824.0 /Review Location Survey v ,f <br /> ESTIMATED CONSTRUCTION COST: and available options. e./� <br /> � <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Disio []Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> QYes EINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 01'eso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? u es ✓ o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> Yes [�10 ODon't know <br /> 6. Is a location survey required? (see reverse) _— Q- es OW 7. Is this to correct a violation? <br /> ' r /,) f9 AP UCATION MUST BE SIGNED <br /> (�{/ V ontinue on Back) -+ -0 -► <br /> 545-112(4/08) <br />