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• <br /> TOWN OF PERRY <br /> PERMIT APPLICATION <br /> 1. NAMES—Owner Applicant(if other than Owner) <br /> Name Rflfl L ci—k \VILA; Name <br /> Street '5 Valet Rd Street <br /> City, State,Zip FDiet.oc• v, 1,' '' <br /> l�.r l 5:�;1L•- City, State, Zip <br /> Phone: Days'A -Z(1r-1 Eves 6-t).-7-r'I I C Phone: Days Eves. <br /> 2. PROPERTY LOCATION Property address: <br /> Section: r Property size: •�i,SjcL Property zoning: _}f"3 Parcel No.: �'_ ) I %� <br /> Legal description: 1/4, sr 1/4, Section , T ;N, R L�ti,i) E <br /> 3. PROJECT DESCRIPTION - Please attach sketch or diagram <br /> 0 Site Plan per attached <br /> IN Building: Dwelling Detached garage or other outbuilding Accessory building it( Addition <br /> 0 Mobile Home: Mobile home= feet by feet; Length of time estimated on site: <br /> Intended purpose: <br /> D Driveway Construction Contractor: <br /> Driveway Ag. Field road Proposed road length: feet <br /> Maximum slope before construction: _% Maximum slope after construction: _% <br /> 0 Zoning Change <br /> Zoning change from District, to District, for acres <br /> Conditional use permit for <br /> Reason for change <br /> 0 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 /> 4. EXHIBITS ATTACHED(see Applications Guide; submit Original+8 copies of application&each exhibit) <br /> Plat map )(Aerial photo Soil/slope analysis 1x 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 <br /> policies in the Town of Perry's Land Use Plan and Building Permit Ordinance and(2)that all information provided in this <br /> application and its exhibits is true and correct and that any subsequent change from these documents requires approval in <br /> advance from the Town Board.The required fee(see Applications Guide)is also attached. <br /> � � y )// <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 /> $300.00-Accessory Buildings[Ag. and non-Ag.j; Detached Garages. <br /> $300.00-Conditional Use Permit. <br /> $ 15.00-Additions,decks,attached garages. <br /> _County erosion control plan_County sanitary permit(for dwellings) _WI Admin. Building Permit <br /> Neighbor notification receipts _Driveway inspection report Cty zoning permit Cty farm income certification(A-1 Ex) <br /> Return with fee and exhibits to: Mary L. Price, Clerk, 1004 Hwy 78, Mt. Horeb, WI 53572 <br />