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.---,0S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App r <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> State at Main Development LLC ❑Zoning Statu ; c <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restric ; CSM <br /> 200 N.Main St,Oregon,WI 53575 Variance(#_ ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)835-3900 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includviKnsions <br /> AGENT NAME CONTRACTOR NAME <br /> Tom Jones Gorman General Contractors ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 200 N. Main St. 200 N. Main St. <br />" (City,State,Zip) (City,Slate,Zip) ❑Seks <br /> Oregon,WI 53575 Oregon,WI 53575 <br /> PHONE PHONE ❑Site <br /> 608 835-3455 (608) 835-3455 a li Ishetvrlfrom <br /> o i . <br /> ( ) ( ) Pp ship. <br /> ADDRESS E-MAIL ADDRESS <br /> tjones @gormanusa.com tjones @gormanusa.com ❑ Floor plascale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati0 Of roperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE <br /> ❑NUMBER R-4 0.30 frontage r wn to scale. <br /> TOWNSHIP: O'10 4b b EICTION: <br /> Town of Windsor 29 1/4: SE 1/41/4: sw ❑ Driveway p ifr <br /> ADDRESS (state, COUIt w ) <br /> fr •f C� �` � ❑Sanitary permits <br /> CSM: 41:04-fr. <br /> 27 SUBDIVISION BLOCK"LOT <br /> Prairie Creek (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Construction of a new home U Zoni D trict <br /> . 151This project is a new building or structure. Li Permitter <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER E EPTIC /existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: of including asement) <br /> 28.5 2.0 U Wetla d/ I dplain/ <br /> Shore hment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: � U Erosion or rol permit <br /> 932.0 �a,aL.lJ 4 TOTAL SQUARE FOOTAGE: + (slop:,. A. .ance. <br /> 2ND FLOOR: 3RD FLOOR: lice, fl I I I n• ac —Ss) <br /> 932.0 4;ez $3 <br /> 6121 Review _0l1'% Survey <br /> ESTIMATED CONSTRUCTION COST: and a -.le .-• is s. <br /> (Please round to nearest dollar) —10. '♦ —0. —or ♦ 170,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes is No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑✓No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ONo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> j 6. Is a location survey required? ( v ) l►_ � es ❑No Don't know <br /> 7. Is this to correct a violation? 111 es IN No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 1 545 112(4/08) <br />