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TOWN OF PERRY <br /> PERMIT APPLICATION <br /> 1. NAMES—Owner Applicant(if other than Owner) <br /> Name _ ! urt Pe Ci J Lt Sr 1,1 ikillcu-t n Name ; (Yci',.se . tQt i4 i <br /> Street ZL R v SLxtha.r) CJ <br /> M0.p,Q, LcuA Street .39 L'c1 S. Cec il:Thy f2cil I - <br /> City,State,Zip 1i 2XLna f l:v I 3 City, State,Zip Pi cot L p c z4 . Ii1 i+ S-3.63-70 <br /> Phone:Days Eves 7.3?-c-'f 5 Phone: Days 71 5-S'EfveS? s <br /> 2.PROPERTY LOCATION Property address: L0 -`'S `t 7 <br /> Section: -a(0 Property size: He C.cr S Property zoning:F,-f Ex Parcel No.: r n tp - a(A3- CJ OC 0 73 <br /> Legal description: S ifs( 1/4, SI/V 1/4, Section dig . T 5 N, R ( •E <br /> 3. PROJECT DESCRIPTION -Please attach sketch or diagram <br /> VSite Plan j!per attached 0 Conditional Use permit <br /> N/Building: Dwelling Y Detached garage or other outbuilding.. Accessory building Addition <br /> • <br /> — <br /> Mobile Home: Mobile home= feet by feet; Length of time estimated on site: <br /> Intended purpose: <br /> NY/Driveway Conssuction Contractor <br /> Driveway V Ag. Field road Proposed road length: feet <br /> Maximum slope before construction: _% Maximum slope after construction: _% <br /> ''Zoning Change <br /> Zoning change from l+,l-i�X District, to P F+—1 District, for 3 acres <br /> Conditional use permit for <br /> Reason f o r change -k; build n S i nnic -raj/11i r Qc i tip y(r ui r1 LO-kiU i(CL i1,16) <br /> vc. <br /> Land Division Size of parcels to be created: ) <br /> t Parcel 1) acres; Parcel 2) acres; Parcel 3) acres; Parcel 4) acres <br /> Principal reason for land division (decribe): <br /> ❑ Communications Tower <br /> 4. EXHIBITS ATTACHED(see App'cations ide-submit Or . r. : co•'es of application&each exhibit) <br /> Plat map Aerial photo - . Soil/slope analysis Site plan Sewage system site suitability <br /> NOTE:A zoning/building De • •y • ' - - _ no Dept.pnorto construction. <br /> 5.AUTHORIZATIONS <br /> By my signature below, I certify the following:(1)that this application—to the best of my knowledge—is consistent with the <br /> Town of Perry's Land Use Plan and Ordinances and(2)that all information provided in this application and its exhibits is true <br /> and correct and that any subsequent change from these documents req pres-,pprov in advance from the Town Board.The <br /> required fee(see Applications Guide)is also attached. <br /> r <br /> Owner(signature is mandatory) Date Applicant(if other than Owner) Date /CV l i/i5 <br /> FOR TOWN USE ONLY: <br /> Fee of$ $550.00-Dwellings,Zoning Changes,Driveway Construction,Site Plans_ <br /> $500.00-Communications Tower <br /> $300.00-Accessory Buildings[Ag_and non Ag.];Detached Garages. <br /> $300.00-Conditional Use Permit <br /> $ 15.00-Additions,decks,attached garages_ <br /> Return with fee and exhibits to: Mary L. Price, Clerk, 1004 Hwy 78, Mt. Horeb, WI 53572 <br />