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DANE COUNTY ZONING PERMIT DCPZP INGPER5--00774 Page 1 of 2 OWNER INFORMATION AGENT/CONTRACTOR INFORMATION OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE STATE AT MAIN DEVELOPMENT LLC (608) 835-3900 Gorman General Contractors (608) 835-3455 BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) 200 N MAIN ST 200 North Main Street (City,State,Zip) (City,State,Zip) OREGON, WI 53575 Oregon, WI 53575 E-MAIL ADDRESS E-MAIL ADDRESS tjones @gormanusa.com PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 0910-293-6254-0 TOWN OF WINDSOR 29 SW SE PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE (Assignment of new address is 6647 PRAIRIE CREEK RD subject to field verification.) LOT BLOCK C.S.M.NO.or PLAT NAME 24 PRAIRIE CREEK SUBDIVISION ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE R-4 Residence Description:sfr w/coy frt por,2 escape wells,at-grade patio 101 -SFR (detached) District Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. ❑ Other: Public 7019 ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION E-All Other DCPZP-2006-09079 ❑ YES ❑ NO SHORELAND FLOOD ZONE WETLAND EC/SW NO. ❑ YES ® NO ❑ YES ❑ NO ❑ YES ❑ NO HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET 4128 22 Sq.Ft. 1680 Sq.Ft.2448 PROJECT COST NO.OF STORIES 2nd FLOOR 3rd FLOOR $170,000.00 1 Sq.Ft. Sq.Ft. PERMIT FEE $359.60 I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure to comply with any provision or condition of this permit renders this zoning permit null and void and subject to enforcement action. I acknowledge that I am responsible for complying with State and Federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be • difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources web page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the purposes of determining compliance with the zoning ordinances. Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner/Agent DATE: Ordinances.Any unauthorized change from the information or plans submitted will invalidate the permit. 4i ZS I cm /, OFFICE USE ONLY (form version 03.00.07) SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS 09/23/2015 RLB YES ❑ NO DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS Initials: E C ,--S S 1� /%