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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 /> OWNER ADDRESS (Number,Street,City,State,Zip) Q Zoning Status; CUP; <br /> D <br /> 5833 Grassland Terrace, Marshall,WI 53559 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 1 (608)225-4594 ambiancehomesinc@charter.net 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 0 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 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us!) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> QPARCEL 012/0911-184-1522-0 A-1 0.85 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ' N <br /> Bristol 18 1/4: _.NEB '%'A: -6E. 12 Driveway permits <br /> ADDRESS: (state,county,town) <br /> . Kaltenberg Pass <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 S�[lltary permits <br /> 12 Burnson's Ridge (public,private) <br /> PROPOSED PROJECT INFORMATION ` STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residential ❑toning District <br /> . 0 This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: QIRur I Address <br /> EWER [EPTIC 13,201,600,377 (ne /existing). <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) 4� <br /> 25.0 1.0 Cl Wetland/Fioodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoretand (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 2,047.0 3,258.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,-disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 <br /> 5,305.0 <br /> ❑ Review Location Survey r �''\,J <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -+ ♦ ". -+ ♦ '♦ $ 255,000.00 ! `'� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ✓Jlo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes allo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes :Ilo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes allo <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 allo ['Don't know <br /> 7. Is this to correct a violation? [Yes ENo <br /> � ) ? APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 's'i 1 / i ( (Continue on Back) -► -► -► <br /> I <br />