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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 /> 4 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5833 Grassland Terrace,Marshall,WI 53559 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 /> 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 IN 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 io Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 P Perty <br /> ❑PARCEL 012/0911-184-1533-0 A-1 1.08 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 18 'r/4. NE x/41/4: SE 4 Driveway permits <br /> ADDRE IR an (state,county,town) <br /> o}( Kaltr' berg Pass <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> 13 Burnson's Ridge (gublic,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential Illi Zoning District <br /> . 0 This project is a new building or structure. ❑Iermitted 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 ,600,255 existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 21.0 1.0 LI Wetland/Fl plain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrela (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionContr ermlt <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: (slopes,d' S rbance, ,1 <br /> 2ND FLOOR: 2,092.0 092 0 3RD FLOOR: �'515.0 g/ <br /> 0.0 0.0 5,607.0 ❑ Review Location Survey ri,6 <br /> ESTIMATED CONSTRUCTION COST: and available o tions. <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 pond or lake? ❑Yes ✓❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓ o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes v' lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes d❑No <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) QYes OW ❑Don't know <br /> 7. Is this to correct a violation? Des :No <br /> j APPLICATION MUST BE SIGNED <br /> 545.112 t4/08i i 'Q` s (Continue on Back) —► —►3 <br />