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DANE COUNTY ZONING PERMIT DCPZP2016-00431 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> STEPHANIE KLECKNER (608)225-4594 AMBIANCE HOMES INC (608) 225-4594 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5833 GRASSLAND TERRACE 994 CHANDLER LANE <br /> (City,State,Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 SUN PRAIRIE, WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KEVINKLECKNER @CHARTER.NET AMBIANCEHOMESINC @CHARTER.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0811-123-4128-0 TOWN OF SUN PRAIRIE <br /> 12 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 5833 GRASSLAND TER <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 14162 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> R-1 Residence 1 Description:INGROUND POOL 18X36 329-Other <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO, VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 8249 ❑ YES NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 648 <br /> Sq.Ft. Sq.Ft 648 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $40,000.00 <br /> 0 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $98.60 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County " :(; : Owner/A e ^ <br /> Ordinances.Any unauthorized change from the information o � — r .tA. • <br /> 1 <br /> plans submitted will invalidate the permit. \ <br /> _I mil <br /> OFFICE USE ON:_f (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 07/14/2016 DJE1 <br /> ES NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br />