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3brnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning A minlstrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r N 0 <br /> N <br /> C <br /> OWNER /�a�Q L D AIC-71_ S 6,0�) TELEPHONE 3�j �� �QIJ n <br /> HOME ADDRESS dJ pk 7 R It (� `!5 y�' 7 v <br /> EMERGENCY/FIRE NUMBERy o 9 ROAD NAME <br /> 3 <br /> LEGAL DESCRIPTION(see tax receipt) / PRI1 be;h)5 R t u Ell? 7 r n tS <br /> a. <br /> h0 o) <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> n <br /> rn <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR / In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. S O <br /> / l <br /> 7;7 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Pu`�/J�, - �' ��Ip 0 a <br /> pl <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ' 7✓' ' 6 �n n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �° <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. JU <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0= <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'ciiZ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. L � 0 <br /> 5. Ve2l�f/o.v 13LLI w4A/ti 36�: - CJS P-W4� VC! YeS recQ b� �lavl(,� z v o e o v <br /> r <br /> - f7P-f-.S !4.$ P�✓" r /�' �lSs cv f.Sc J'� - 0 � 3 'a m x a � A <br /> 6. / Q N 5 5 v N C N y o <br /> 7. o y �Ki i <br /> m' . m <br /> I declare that this application (including any accompanying e�dule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I ack; g'$ 6ae ponsible for the detail and accuracy of a m i� E <br /> t CD <br /> all information contained in this application(including any,jaa s ltgdu` eclare that I recognize m <br /> that this information I am providing will be relied upon by t< rmining whether to is- U .sue a permit. 1 further accept all liability which may be ae County o u this information I am :providing in this application. I agree to permit county ofr ith administering u ty ordinances or othermauthorized person to have access to the above describedtVeaso a for purpose of inspection. m <br /> � m :pFQ' -CR fD <br /> SIGN URNU HERE ICYQ/YA�G� G / �� � N �I`CC), <br /> , � <br /> ( n lure of owner qr b Iding contractor) C-FaR, A' Nr (date) <br /> ZONING ADMINISTRATOR 4!"1 e�147 � <br /> t»tntnwwF» <br /> N N (nNN(n M <br /> (n (n 0 (n fn 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> /'��,, 0000000 <br /> u1..r,_ SeYJT_zJ—�q--1-g <br />