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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVI E <br /> OWNER NAME <br /> Ambiance Homes Inc <br /> O Zoning Status; CUP; 2 j )t <br /> 9 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM � <br /> 5833 Grassland Terrace,Marshall,WI 53559 Variance(# ) <br /> HOME PHONE i CELL PHONE E-MAIL ADDRESS <br /> 608 <br /> ( )225-4594 ambiancehomesinc @ charter.net 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ambiance Homes Inc Ambiance Homes Inc _V Site ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS O wel septic <br /> 5833 Grassland Terrace 5833 Grassland Terrace <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks 3 O/ 0/C4" ) <br /> Marshall,WI 53559 Marshall,WI 53559 / <br /> PHONE PHONE 0 Site Plan approval from i/ <br /> (608) 225-4594 (608) 225-4594 applicable township. /V ill- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @ charter.net ambiancehomesinc @charter.net 15I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property ' <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 058/0811-123-4155-0 R-1 DCPREZ-0000-08249 0.59 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Sun Prairie 12 +/: SW +�4+�4: SW Q Driveway pe� <br /> ADDRESS (` 2.6 <br /> (state, count ,town) ' <br /> �JJ� Grassland Terrace <br /> NI <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Sanitary/ s <br /> 15 Savannah Valley (public,�t rivate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /� , <br /> Single Family Residential C 0 v Y 4- r�t' , GI ''c 7C JSS' Zoning District S <br /> 1/I This project is a new building or structure. t7 „ Permitted Use? K- <br /> � ,+ <br /> ❑This project is an addition/alteration to an existing building or structure. C 7 L! <br /> SANITARY SERVICE: PERMIT NUMBER: ddress O T <br /> [EWER [EPTIC new/ xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 21.0 1.0 tVetland/Floodplain/ A74_ <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: 1ST FLOOR: ErosionControl permit �{—^ <br /> 2,047.0 3,257.0 j. TOTAL SQUARE FOOTAGE: + slopes,disturbance, r It <br /> f2ND FLOOR: 0.0 3RD FLOOR: 0.0 5,304.0 ,� A r <br /> . Review Location Survey .--7--f f <br /> ESTIMATED CONSTRUCTION COST: v \and available options. <br /> (Please round to nearest dollar) —' '♦ —* —' $ 265,000.00 p (' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? ��� / <br /> p p y p o ❑Yes ❑✓No ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? DYes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes rANo <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 ❑Don't know <br /> 7. Is this to correct a violation? — —_► - ONo <br /> �(�`° APPLICATI'N MUST BE SIGNED 1-1 545-112(4�) �I (J (f (Conti - on Back) -- —, —► <br />