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i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> State at Main Development LLC 20o( — ? 0 <br /> - 0 Zoning Status; CUP; R_ 9 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) T Deed Res r• .tinn;, <br /> 200 N.Main St,Oregon,WI 53575 ante(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS cfe Y4 i S <br /> (608)835-3900 ❑Site an drawn to scale �'✓ <br /> PAc14:1 A 1:11.1:4 U.111[•1: • . , _ O- . 0; 11 _ 0• ..-- -onS .d o< e <br /> AGENT NAME CONTRACTOR NAME / c 1,^ <br /> Tom Jones Gorman General Contractors ❑ Site Plan including locatio 1 (? <br /> AGENT ADDRESS CONTRACTOR ADDRESS • <br /> 200 N. Main St. 200 N.Main St. ketbacks(City,State,Zip) (City,State,Zip) 3 8 fc7 (19/1_c - <br /> Oregon,WI 53575 Oregon, WI 53575 <br /> PHONE PHONE - Site Plan approval from <br /> (608) 835-34. 5.5 (608) 835-3455 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tjones @gormanusa.com tjones @gormanusa.com S1 Floor plans to scale iI <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us i! Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING 'ACREAGE: <br /> ❑PARCEL 068/0910-293-6265-0 R-4 0.26 rontage drawn to scale. <br /> NUMBER L 2 <br /> TOWNSHIP: SECTION: <br /> " Driveway ermi r J <br /> Town of Windsor 29 1/4: SE 1/41/4: SW �� Y P <br /> ADDRESS'/ , ��r <br /> fp6q3 Pr e- I' ► c. C r /C e04c2 <br /> CSM: LOT 25 SUBDIVISION BLOCK/LOT ❑ 'ry permits 20 Z I <br /> Prairie Creek (public private) <br /> PROPOSED PROJECT INFORMATION —.mow VIEW <br /> PROJECT DESCRIPTION: <br /> Construction of a new home C o v F4- 0 r, 2_ Es Ca 9 C- ` !1 Zoning District " 11 <br /> V" <br /> Q This project is a new building or structure. C I(S ? I 9 rah' 4 Permitted Use? 9 f--�— <br /> ❑This project is an addition/alteration to an existing building or structure. fad 1 <br /> SANITARY SERVICE: PERMIT NUMBER: 2..., x R .1 Address <br /> PIEWER r)EPTIC 26( I Isting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) A ' <br /> 22.3 1.0 W Floodplain/ >/kV <br /> horela (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErOSIOnCOntr01 permit 1 I f TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance. �G I/ <br /> 16,0q "Zi OI f , filling/access) A f f r <br /> 2ND FLOO : 3RD FLOOR: <br /> 14 y <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► ♦ ♦ and available options. <br /> (Please round to nearest dollar) 170,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? fees ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives ao ❑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? Yes ONo <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) . Dies No ODon't know <br /> 7. Is this to correct a violation? Eyes ONo <br /> y�� l ( S �e- 351 ) 0C APPLICATION MUST BE SIGNED <br /> /) /I > (Continue on Back) -+ <br /> 545 112(4/08) <br /> r5, e9, <br /> �,/) /� •� 1 ( ) <br />