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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) NI Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> 5838 Grassland Terrace Marshall,WI 53559 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)225-4594 ambiancehomesinc @charter.net Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and 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) ! 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 IN Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> EPARCEL 012/0911-193-0100-0 A-1 1.01 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 19 1/4: NE WA: SW 0 Driveway permits <br /> ADD (state,(state,county,town) <br /> S( J Parker Pass <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 1 Parker's Place (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential ❑ Zoning District <br /> . IN 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: ❑ `• -I Address <br /> EWER 1EPTIC 13,201,500,136 existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22.5 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 2,165.0 3,379.0 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0.0 5,544.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -i -' ♦ -♦ -' $ 230,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eves ✓alo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes jlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes aio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes laio <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> Q Y <br /> 6. Is a location survey required? (see reverse) es 'lo ['Don't know <br /> 7. Is this to correct a violation? QYes ✓ilo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -r -► <br /> 545-112(4/08) <br />