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DANE COUNTY ZONING PERMIT DCPZGPERMI-00766 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME 'PHONE AGENT/CONTRACTOR NAME PHONE <br /> AMBIANCE HOMESINC (608) 225-4594 AMBIANCE HOMES INC (608) 225-4594 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5833GRASSLAND TERRACE 5833 GRASSLAND TERRACE <br /> (City,State,Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 MARSHALL, WI 53559 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ambiancehomesinc @charter.net ambiancehomesinc @charter.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-194-4534-0 TOWN OF BRISTOL 19 SE SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6919 OSLO LN <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 4 LEHMAN'S ADDITION <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 1.38 Description:sfr and covered porch and deck 101 - SFR (detached) <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private 13201600336 <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4777 <br /> 29.0 Sq.Ft. 1133 Sq.Ft.2545 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $255,000.00 <br /> 2 Sq.Ft. 1099 Sq.Ft. PERMIT FEE <br /> $408.28 <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 zon' • ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SI T RE: •wn:r/Agent DAT-. <br /> Ordinances.Any unauthorized change from the information or <br /> der ( ( ZS/ /� <br /> plans submitted will invalidate the permit. <br /> OFFICE USE ONLY (form version 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 11/28/2016 SSA1 <br /> YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initial/ <br />