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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) 0 Zoning Status;CUP; I <br /> Deed Restriction; CSM <br /> 5833 Grassland Terrace,Marshall,WI 53559 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> (608)225-4594 ambiancehomesinc @charter.net 0 Site Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5833 Grassland Terrace 5833 Grassland Terrace <br /> (City,State,Zip) (City,State,Zip) 0 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. V <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/) Elevation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 P P rty <br /> 0 PARCEL 012/0911-121-0153-0 A-1 0.73 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ��rivewa permits <br /> Bristol 12 '/a: NE �'�"�1/a'/a: NE -■ y p <br /> IliEr- \mL,- (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> 53 (public,private) <br /> Drumlin Creek <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential � " oning District <br /> . 0 This project is a new building or structure. li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ - :, address <br /> EWER [EPTIC 13,201,600,026 new/ xisting) <br /> HEIGHT IN FEET: 21.0 NUMBER OF STORIES: (Not including basement) hr ,Vlletland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: I'750.0 1ST FLOOR: 3,035.0 j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fi g/access) <br /> 0.0 0.0 4,785.0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -i -' ♦ -- -' ♦ $ 250,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes Dslo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? EJYes g Q <br /> o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ✓ lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes ✓ 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) 'Yes ao ['Don't know <br /> 7. Is this to correct a violation? LJYes EINo <br /> (p$" <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► <br /> 545-112(4/08) <br />