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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 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 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 <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION I 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) 0 Setbacks <br /> Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE PHONE MI 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 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑PARCEL 012/0911-194-4523-0 A-1 1.50 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 19 1/4: SW WA: SE 151 Driveway permits <br /> ADDRESS: (state,county,town) <br /> % o two Lane (0i6 Oslo <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> L (public,private) <br /> Lehman's Addition <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,.,,.,,� <br /> Single Family Residential Fla ning District <br /> . ©This project is a new building or structure. i.1d'Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R Address <br /> EWER DEPTIC 177S—Cp- C 7 new/e fisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22.5 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: t ST FLOOR: 1--. ErosionControl permit <br /> 1,961.0 3,056.0 j. TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0.0 5,017.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -' ♦ -► -' -' -r $ 225,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Bo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EINo <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 �10 ❑Don't know <br /> 7. Is this to correct a violation? :Yes OW <br /> 4-Ltr Lo g% <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(aos) <br />