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DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> Page lot2 <br /> DCPZP-2015-00526 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> AMBIANCE -TOMES INC (608)225-4594 AMBIANCE HOMES INC (608) 225-4594 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5838 GRASSLAND TERRACE 5838 GRASSLAND TERRACE <br /> (City,State,Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 MARSHALL, WI 53559 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @charter.net ambiancehomesinc @charter.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-183-6518-0 TOWN OF BRISTOL 18 SW SE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of nsw address is 3127 LORRABUD LN <br /> subject to field vi riflcation.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> CSM 14000 <br /> ZONING DISTRIC r PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 AgricL ItL re 0.89 Description: 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial El Agricultural SEWER SANITARY PERMIT NO <br /> ❑ Other: <br /> Private 13-201-00224 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Otter ❑ YES 0 NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES p NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4813 <br /> 21.5 Sq.Ft. 1866 Sq.Ft.2947 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $220,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $410.97 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowleige that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County i N• URE: Own: / • - t DATE: <br /> Ordinances.Any Unauthorized change from the information or . <br /> plans submitted will invalidate the permit. � <br /> OFF CE USE ONLY (form version 03.00.07) <br /> SURVEY REQUIPED? DATE ISSUED INITIA' 1st INSPECTION DATE INITIALS <br /> ES ❑ NO 07/15/2015 SSA1 <br /> 9,V <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br />