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PERMIT APPLICATION Uchana"Ib~ Appleton, WI 54915 13 Aac;;:&;;:Wm Phone: (920) 734-8599 APPLICATION#: J,OJO-Tjlg

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PERMIT APPLICATION Uchana Town of Buchanan GENERAL BUILDING & ZONING ~ N178 County Road N PERMIT APPLICATION uchana"ib~ Appleton, WI 54915 13 aac;;:&;;:wm Phone: (920) 734-8599 APPLICATION#: J,OJO-tJlg Applicant/Contractor lnfonnatlon Applicant Name (lndlv., Org. or Entity) Authorized Representative TiUe Modem Sheet Metal Megan Krieser Bookkeeper Malling Address City State IPostal Code 2180American Dr Neenah WI 54915 E-mail Address Telephone (include area code) Fax (Include area code) [email protected] 920-733-4713 920-733-0882 Landowner lnfonnatlon (If different than Applicant) Name (Organization or EnUty) Contact Person TiUe Bob Granger owner Mailing Address City State IPostal Code N280 Rogers Ln Appleton WI 54915 E-mail Address Telephone Onelude area code) Fax (Include area code) 920-788-1614 Project or Site Location Site Address I Location: Parcel ID(s): IPlat I CSM I Lot No.: N280 Rogers Ln tJ300Fh300 Current Zoning: I Current Use: Lot Dimensions: Front: Side: Rear. Side: I LotArea: 0 acres or D square feet Project lnfonnatlon Structure: ~ Trades: §enia~ - f!lacigal a1dg.; §el!li!.!l!s!i -Accessoa a1i;tg.: Iii Principal 0New D Plumbing Front: Side: Front: Side: 0Accessory 0Addition D Electrical Rear. Side: Rear: Side: 0 Other. liJ Other. liJ HVAC bQl CoJ1:er1ge; Laad Disturbance; fmleg !&§gtoUsm; Existing: Area (Sq Ft): Replacement of 1 furnace Proposed: Fill/Ex (Cu Yds): Any IBJICI disturlling aclivltles over 4.000 squa1& Estimated Cost of Project: feat or /UJillfl & excavation IDIBllllfl over 100 cubic Height (to peak): yards 1&qu/18S a saparate erosj)n control & $3,649.00 stonnwater mamigement pennlt. Project Plans (see reverse side) 0 SitePlan 0 Building Plans D Grading/Drainage & Erosion Control Plan/Permit Additional Requirements (Check all that apply) 0 Special Exception No. 0 Shoreland Zoning Permit No. 0 FloodwaylFloodplain 0 Sanitary Permit No. 0 Gamers Creek Stormwater Utility Permit No. ___ Conditional Use Permit No. Zoning Administrator Remarks: Acknowledgement, Certification & Pennisslon Acknowledgement: The applicant & landowner agree to comply with all applicable codes/zoning ordinances, state statutes, local, federal and state building code requirements and with the conditions of this permit; understands that the Issuance of this permit creates no legal liability, expressed or implied by the Town of Buchanan; and cerl/fies that all the Information stated above is hereby conect Certification: The applicant & landowner certify that the information contained in this form and attachments is true and accurate. I understand that failure to comply with any or all of the provisions of Town Ordinances and/or permit may result in notices, fines I forfeitures, stop work orders, permit revocation, and cease & desist orders. Pennlsslon: The landowner hereby gives the permit authority permission to enter and inspect the property to evaluate this permit application, to determine comcliance with the ordinances, and to cerform corrective adions after issuina orocer notice to the landowner. Applicant Signature ~ ~ Date 12/05/19 Landowner Signature 0J.A-cvlfl t. t)) Date)~'"c'i 0 -r)o/a, Ila+ , , - ./V LEAVE BLANK- FOR TOWN USE ONLY Fee(s)$: t/tJ.OC I Receipt No: t/Jjf8J Date ReceiVed: /-;.) ~ Zoning Review: Building Inspector Signature: Date Issued: lnsp Completion Date: BPl-101 General Permit Application (Rev 2-1-16) D Town Copy (Original) D Inspector Copy D Owner/Applicant Copy ·:: .·.: .... ; ··'·.::. ·. .. ..... ·.:· ' .. ··. :;,· ·.::· . ,... ··.. ·.. ·:. ~.... ~ .: •' ,A') Town of Buchanan GENERAL BUILDING & ZONING ........ ~ N178 County Road N PERMIT APPLICATION Buchanan") Appleton, WI 54915 .......... ,. ...... · Phone: (920) 734..S599 APPLICATION #: d~o-o'-/ q Applicant/Contractor Information Applicant Name (lndiv., Org. or Entity) Authorized Representative TiUe !:Ji 7...1\hf,\.h 7-o..Y-i MalUng Address City State :Wlci1 ~ rn'\\)(\~ ll.d. Am\1m(\ \NL 1Pog~~5 E-mail Address fcelep6\~~clude area code) Fax (include area code) e..hwhf \hll\.\\ lD \\ ?1W u r.t.h oo ."~ lld-D- R-,&;\4q Landowner Information (if different than Applicant) - Name (Organization or Entity) Contact Person ritle Mailing Address City State IPostal Code E-mail Address Telephone (Include area code) Fax (include area code) Project or Site Location Site Address I Location: Parcel ID(s): l Plat I CSM I Lot No.: wiq 2..~ ~('('\f)r'\,\ ~ 030 \S< "\l1lit1 t oon Current Zoning: R.e. \) At..l('\lfe 0 I Current Use: lj(·, f'I\."•$• 1 N' "'A 1 I'\. ,JJ Lot Dimensions: Front: Side: Rear: Side: ' I Lot Area:J 0 acres or 0 square feet Project Information §trugure; Im;. Trades: Sgtbacks - Priacieal Bldg.; Sel!;!acks -Accesso~ Bldg.: 0Principal 0New 0Plumblng Front Side: Front: Side: {2J Electrical Rear: Side: Rear: Side: 0 Accessory '* rnAddition OJ.Other:«>~gJt~\ Oother: fi) HVAC Lot Covemge: Land Disturbance: Pro!eg Descrj!ltion: ~ Existing: Area (Sq Ft): Proposed: Fill/Ex 1eu vc1s1: df1~~1 \>~~~~-:~~~~ Any land distwfl/ng activities 01181' 4,000 square v Estimated Cost of Project: feet or filling & excavalion totaling over 100 cubic Height (to peak): yards teqUit88 a sepatllfe erosion conl10/ & $ 5, l)D0 &lotmwaler mamigament permit. Project Plans (see reverse side) 0 SltePlan 0 Building Plans 0 Grading/Drainage & Erosion Control Plan/Permit Addltlonal Requirements (Check all that apply) 0 Special Exception No. 0 Shoreland Zoning Permit No. 0 Floodway/Floodplaln 0 Sanitary Permit No. 0 Buchanan Storrnwater Utility Permit No. Conditional Use Permit No. Zoning Administrator Remarks: Acknowledgement, Certification & Permission Acknowledgement: The applicant & landowner agree to comply with all applicable codes/zoning ordinances, state statutes, local, federal and state building code requirements and with the conditians of this pannit; understands that the issuance of this pannit creates no legal liability, expressed or Implied by the Town of Buchanan; and certmas that all the lnfonnatian stated above is hereby correct CertlflcaUon: The applicant & landowner certify that the Information contained In this form and attachments is true and accurate. I understand that failure to comply with any or all of the provisions of Town Ordinances and/or permit may result in notices, fines I forfeitures, stop work orders, permit revocation, and cease & desist orders. Pennlsslon: The landowner hereby gives the permit authority permission to enter and inspect the property to evaluate this permit application, to determine comoliance with the ordinances, and to nerform corrective actions after lssuina orooer notice to the landowner. Applicant Signature ~ -a A Date I /J r/i 7 "'--- /?({,.,( 13 CJ-0 Landowner Slgnatuf~J~ / Date 1 /1 ".:? /62-r ·- ~ ~~""' LEAVE BLANK- FOR 10WN USE ONLY Fee(s)$: J9,f) . l Receipt No:q3~qL{ Date Received: 113 J Q,) 1 Zoning Review: Building Inspector Signature: Date Issued: lnsp Completion Date: BPI-IOI General Permit Application (Rev 7-12-2018) CJ Town Copy (Original) Cl Inspector Copy '.J Owner/Applicant Copy ,A) Town of Buchanan GENERAL BUILDING & ZONING .. ~ .... ~ N178 County Road N PERMIT APPLICATION Buchanab Appleton, WI 54915 ...................... Phone: (920) 734-8599 APPLICATION#: ~o1o-C5.fi_ Applicant/Contractor Information Fax (include area code) Title wState Fax (include area code) Project or Site Location Plat I CSM I Lot No.: Current Zoning: Current Use: Lot Dimensions: Front Side: Rear: Side: Lot Area: 0 acres or 0 square feet Project Information Structure: ~ Setbacks - Princioal Bldg.: Setbacks -Accesso!Y Bldg.; 'i?) Principal Front Side: Front: Side: 0 Accessory Rear: Side: Rear: Side: l.!:D=-::o:.:t:.::he=r:.:.:.====;:::....~~Oth==er:~. ====:ll-=~.:.:...:.::.__J Lot Coverage: Land Disturbance: proied Description: 8" '1e 24' ,ll.D_b1rf0,.I 7"6 Existing: Area (Sq Ft): llollSt t;P Proposed: Fill/Ex (Cu Yds): -------------------------'"-----------' feetAnylanddistutlJ/ngadivltieso1111r4,000square or 611/ng & excavation totaling over 100 cubic Height (to peak): yards l8qUftes e separate erosion conllDI & stonnwater management pennil. Project Plans (see reverse side) 0 SitePlan Building Plans 0 Grading/Drainage & Erosion Control Plan/Permit Additional Requirements (Check all that apply) 0 Special Exception No .. ___ 0 Shoreland Zoning Permit No. ____ 0 Floodway/Floodplain 0 Sanitary Permit No. ____ 0 Buchanan Stormwater Utility Permit No .. ___ Conditional Use Permit No. ____ Zoning Administrator Remarks: Acknowledgement, Certification & Permission Acknowledgement: The applicant & landowner agme to comply with all applicable codes/zoning on:Jinances, state statutes, local, federal and state building code mqulmments and with the conditions of this pennit; understands that the issuance of this pennit creates no legal liability, expmssed or Implied by the Town of Buchanan; and certifies that an the Information stated above Is hemby correct Certification: The applicant & landowner certify that the information contained In this form and attachments is true and accurate. I understand that failure to comply with any or all of the provisions of Town Ordinances and/or permit may result in notices, fines I forfeitures, stop work orders, permit revocation, and cease & desist orders. Pennlsslon: The landowner hereby gives the permit authority permission to enter and insped the property to evaluate this permit application, to determine com n the ordinances, and to erform corrective actions after issuin ro er notice to the landowner. Date LEAVE BLANK- FOR TOWN USE ONL 'f Fee(s)$: IDO, 490 I Receipt No: '1'2 q103 Date Received: /'".)./<)d~ Zoning Review: Building lnspedor
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