Laserfiche WebLink
CONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App S <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME <br /> State at Main Development LLC 7 <br /> /;4 Zoning Status: CUP: Q <br /> OWNER ADDRESS (Number,Street,City,State,Zip) r Deed Restriction: CSM ( <br /> 200 N.Main St,Oregon,WI 53575 V• ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)835-3900 ❑Site Plan drawn to scale ■ <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 /d <br /> AGENT NAME CONTRACTOR NAME L C�lQ <br /> Tom Jones Gorman General Contractors !� Site Plan including location ' <br /> AGENT ADDRESS CONTRACTOR ADDRESS - -- . . . 1 <br /> 200 N.Main St. 200 N. Main St. O/1 <br /> (City,State,Zip) (City,State,Zip) Setbacks 33 8 / <br /> Oregon,WI 53575 Oregon,WI 53575 <br /> PHONE PHONE 01 I - ' an appro .`=gym <br /> (608) 835-3455 (608) 835-3455 applicable ownship. / <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tjones @gormanusa.com tjones @gormanusa.com <br /> Afloor plans to scale i (i <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 'XI elevation of property <br /> PARENT PARCEL NUMBER CURRENT ZONING ACREAGE j _= p p y I <br /> ElPARCEL 068/0910-293-6254-0 R-4 0.25 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTION <br /> Town of Windsor 29 14: f$e ". 1/414; 0:1 Driveway permit <br /> �j� �/ sta - • nt own <br /> ADDRESS / Cv^e_ C./( �Oac(0 <br /> w ..,. <br /> (/6 /{wJ Ct a ✓ 1 <br /> CSM LOT SUBDIVISION BLOCKLOT •ry permits <br /> 24 Prairie Creek <br /> (public, •rivate) , <br /> PROPOSED PROJECT INFORMATION '• a •' <br /> PROJECT DESCRIPTION: fl� '91127 <br /> Construction of a new home Jl rr4 CON)f o rr a 4- q ra de J.-�' a N4 Zoning District 7' 'T <br /> P <br /> . 0 This project is a new building or structure. 11.4yerrritled use Cj <br /> This project is an addition/alteration to an existing building or structure. l! <br /> SANITARY SERVICE: PERMIT NUMBER . 66 7 <br /> RIEWER JEPTIC 2 Of ( t. l'., ;. ,!) <br /> l � <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 21.3 1.0 ,+ $oodplain/ le <br /> AREA TO NEAREST SQUAB F I: - ° , ,- ,. (attachment) <br /> (Outside dimensions inclu ing unfinished area; atia t�I e�and above grade decks or porches) , E tro emit <br /> BASEMENT: 1ST FLOOR: � rq.� <br /> !� 'j" ""'7jj • <br /> 1 , /4 go --F�V.V + TOTAL S U RE FOOTAGE: j - ° # r rbanCe, 6 <br /> 2ND FLOOR 3RD FLOOR: l/v ---i , 01 <br /> 1 0 �',., Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ available Wig, <br /> (Please round to nearest dollar) ♦ "♦ ♦ ♦ ♦ ♦ $ 170,000.00 ,:g`. <br /> gkt4" /._,e_+- �� r 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ONo EDon't know taII, <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 12 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 /> 6. Is a location survey required? (see reverse) ❑Yes ElNo SIDon't know <br /> 7. Is this to correct a violation? Elves 12 No ko k,., 0 vv /DI 25-04) <br /> /i�/ c V v c f I # APPLICATION MUST BE SIGNED ,q <br /> arfc/� <br /> r-> N 1 <br /> (Continue on Back) <br /> I ^ STS A v w .5 15ratcxecv-A <br />