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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 IncRa � , <br /> ,� e_ <br /> (% t ..' 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5838 Grassland Terrace Marshall,WI 53559 n I I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS ` i ow , �# <br /> (608)225-4594 a.-•'. •. .n- � n le Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION /end includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5838 Grassland Terrace 5838 Grassland Terrace <br /> (City,State,Zip) (City,State,Zip) 4 Setbacks <br /> Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE PHONE 0 Site Plan approval from <br /> (608) 225-4594 (608) 225-4594 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @charter.net ambiancehomesinc @charter.net 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: NI Elevation of property <br /> ❑PARCEL NUMBER 012/0911-121-0131-0 A-1 0.83 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Bristol 12 �/4. NE +/1/4. NE I9 Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> �� Li Esker Trail 51 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 51 Drumlin Creek (public,private) <br /> PROPOSED PROJECT INFORMATION ,'' STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential Zoning District <br /> . 51This 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: ❑I'Rural Address <br /> I EWER KEPTIC `3-ZQIS- L� ,0 1 '.(new/existing) <br /> / <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �,' <br /> 24.5 1.0 LI Wetland/Flood"plain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControt permit <br /> BASEMENT: 1 ,669.0 1ST FLOOR: <br /> 2,714.0 j TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0.0 4,383.0 7- <br /> ❑ Review Location Survey, <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ 230,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves ✓❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Elves ✓❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ✓❑ Jo <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) QYes ❑Mo ['Don't know <br /> 7. Is this to correct a violation? ['Yes jVo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) Me 7 (iy „/ (Continue on Back) -i -4. —I. <br />