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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME - i <br /> Ambiance Homes Inc <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status;CUP; <br /> 5833 Grassland Terrace,Marshall,WI 53559 Deed Restriction;CSM <br /> HOME PHONE I CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)225-4594 ambiancehomesinc @ charter.net '1 <br /> AGENT INFORMATION Q Site Plan drawn to scale <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME y <br /> f,°Ambiance Homes Inc Ambiance Homes Inc .` KJ <br /> ;� Site cluding locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/sep <br /> 5833 Grassland Terrace 5833 Grassland Terrace � f2c/(o7O(City,State,Zip) (City,State,Zip) 4 Setbacks C) <br /> Marshall,WI 53559 Marshall,WI 53559 <br /> PHONE PHONE 151 Site Plan approval from lA <br /> E-MAIL ADDRESS (608) 225-4594 E-MAIL ADDRESS (608) 225-4594 applicable township. / <br /> ambiancehomesinc@charter.net ambiancehomesinc @charter.net 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 3 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property b <br /> 0 PARCEL 012/0911-194-4556-0 A-1 1.00 3 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 19 1/4: SW '/4'/.: SE 4 Driveway permit <br /> ADDRESS: 9 (state,county, Wn <br /> 2 Oslo Lane L61/6 <br /> CSM: LOT SUBDNI'.ION BLOCK/LOT 0 Sanitary ''� its <br /> 6 Lehma 's Addition (public, ) 0006 Y <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential Vv ail-Fri-pot 7 f - �y'r�) � of e .j,P c- a(Zoning District A' 7, <br /> NI This project is a new bui ding or structure. i -epS permitted Use? sF/-- <br /> ❑This project is an addition/alteration to an existin building or structure. <br /> SANITARY SERVICE: '►� <br /> PERMIT UMBER: 0 ) 6 ` 0066 y ne Address <br /> EWER EPTIC +' new/ xistiit <br /> HEIGHT IN FEET: ___. NUMBER OF STORIES: (Not including basement) t <br /> 0 u 1.0 KIN odplain/ <br /> AREA TO NEAREST SQUA E FOOT: o eland ttachment) rr(Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ZkErosionControl permit <br /> 2,187.0 3,448.0 , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, To , <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 I 5,635.0 fillin• - _-_ np <br /> (Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -�► ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) $ 265,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? aes EIVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? Dyes lo ODon't know <br /> 3. Have you talked with the township about your proj ct and are they in agreement? Efres Oslo <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? Efres alo <br /> 5. Is this project associated with a rezone/CUP/varia a(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes Dtslo DDon't know <br /> 7. Is this to correct a violation? Yes OW <br /> ,, t-- y 2 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on -♦ <br /> 545-112(4/08) 2 VV (Cti Back) ♦) <br /> p <br />