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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 Q Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5838 Grassland Terrace Marshall,WI 53559 nce(# ) <br /> l HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)225-4594 ambiancehomesinc @ charter.net 4 Site Plandrawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION acludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc a ife 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) 0 £tbacks <br /> �;` Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE PHONE 0 Site Plan ap oval from <br /> (608) 225-4594 (608) 225-4594 applic I wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @charter.net ambiancehomesinc @charter.net 151 to plates to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: '4 ley tion of property <br /> ❑PARCEL 012/0911-194-4512-0 A-1 1.00 ntage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: �\ <br /> Bristol 19 '/a: SW 1/4'/: SE 0 Driveway ermits <br /> ADDRESS: (state ` unty,town) <br /> V 6 9i / Olso Lane IN Sani - permits <br /> CSM: LOT 2 SUBDIVISION BLOCK/LOT •u• ic,private) LI <br /> Lehman's Addition <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential ,T r06t-1( oning District <br /> This project is a new building or structure. [� itted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 45,AIAddress <br /> FIEWER [EPTIC 13,201 ,500,299 <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) <br /> / 21.5 1,0 ❑ Wetland/Floodplain/�' <br /> J (� Shoreland (attachment f4 , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ rosionControl perm <br /> 2,096.0 3,229.0 + TOTAL SQUARE FOOTAGE: ,` lopes,disturbance, 4 .-' <br /> ling/access)_ kb <br /> 2ND FLOOR: 3RD FLOOR: 0.0 5,325.0 <br /> 4342eview Location Surverc i ' <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available option . <br /> LV <br /> (Please round to nearest dollar) $ 235,000.00 \ �} ) <br /> / l/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓❑No ❑Don't know ` <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �/ o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des All o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <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) ❑✓Yes ❑No DDon't know <br /> 7. Is this to correct a violation? Des al <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -. -+ <br /> 545-112(4/08) <br />