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TOWN OF PERRY <br /> PERMIT APPLICATION <br /> 1. NAMES—Owner Applicant(if other than Owner) <br /> /\ <br /> Name Ft G.A 4 wait/ Z, en/%V Name <br /> Street /95Y ire //r r 1gc0 , Street <br /> City,State,Zip MI, t/o ve 6 11Z City,State,Zip <br /> Phone: Day(608)4/37 S1' iies Phone: Days Eves. <br /> 2. PROPERTY LOCATION Property address: <br /> / Property �es5 <br /> Section: size: rPropermty Dzove ng°: Parcel No.: 05Ot -0/3 804/-6 <br /> Legal description: NE 1/4, 5 W 1/4, Section /7/ , T 05'N, R Od E <br /> 3. PROJECT DESCRIPTION -Please attach sketch or diagram <br /> g Site Plan _per attached g Conditional Use permit <br /> X Building: Dwelling Detached garage or other outbuilding_ Accessory building X Addition_ <br /> El Mobile Home: Mobile home= feet by feet; Length of time estimated on site: <br /> Intended purpose: <br /> g Driveway Construction Contractor: <br /> Driveway Ag. Field road Proposed road length: feet <br /> Maximum slope before construction: % Maximum slope after construction: _% <br /> g Zoning Change <br /> Zoning change from District tp District, for ages <br /> Conditional use permit for /. VefTot -7u i ,n, yo <br /> Reason for change <br /> El Land Division Size of parcels to be created: <br /> Parcel 1) acres; Parcel 2) acres; Parcel 3) acres; Parcel 4) acres <br /> Principal reason for land division (describe): <br /> ❑ Communications Tower <br /> 4. EXHIBITS ATTACHED(see Applications Guide;submit Original+8 copies of application&each exhibit) <br /> _Plat map `Aerial photo _Soil/slope analysis Site plan _Sewage system site suitability <br /> __Sketch or diagram <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 requires approval in advance from the Town Board.The <br /> required fee(see Applications Guide)is also attached. <br /> "Rte: De-V2a/i/ <br /> Owner(signature is mandatory) Date Applicant(if other than Owner) Date <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 />