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Burne,County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y � w <br /> OWNER",� ry� `"I -7 <br /> `t-�ARRYG /11 AR��.CC JOknS0A TELEPHONE /�,S 381-531( n <br /> HOME ADDRESS (�0 G0/0.51Aj T• /V � LI o I )) <br /> r (D <br /> EMERGENCY/FIRE NUMBER ROAD NAME 6 <br /> HRT Of CSV Lf.)T / 5'GGT 1 O N <br /> LEGAL DESCRIPTION(see tax receipt) RAAu6E �c�/W E57 'ToW u d f I <br /> DEW 0 ti <br /> CD <br /> }p{ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE JAI ADDITION ❑ ❑ O y c <br /> TYPE OF PERMIT(S): PRIVY <br /> FILLING/GRADING C Cr <br /> PING UNIT ❑ SUBDIVISION ❑ o- <br /> ' S. <br /> STRUCTURE/ADDITION USE: /N H <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> 0 . <br /> BUILDING CONTRACTOR: S Ta✓UE kNrn n "__. rl <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3, <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 C <br /> C <br /> O ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m b <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. ( c Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> Q 0 ` <br /> NEEDED. q <br /> nvl <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z - <br /> CONDITIONS OF PERMIT: o �d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n <br /> PERMITTED. (J <br /> 4. NO STRUCTURES, INCL DrIINNGG RETAINING WALLS, ETC.,ALLOWAD WITHIN THE REQUIRED WATER,(/ <br /> 5. SETRR <br /> E C�� 1/ 7-5SGy q�� <br /> I / ,/ zvvr v �vv <br /> 6. rHi �2Yt S61J $9�Ye� ,`Qj �{f� �S{i- 113 !/ ,ld, m 3 a CD I;X ° <br /> 7. / a m y o " = 3 <br /> O <br /> 1 declare that this application (including any accompanying schedule) h d by me and to the best of my cj c A <br /> knowledge and belief it is true,correct and complete. I acknowledge et I he detail and accuracy of C m C <br /> all information contained in this application(including any accompa g schedu e t I lare that I recognize CD m ' m <br /> that this information I am providing will be relied upon by the C4 Burn Wiscon i t ping whether to is- J p <br /> sue a permit. I further accept all liability which may be a result oft Count ett relying 1 information I am <br /> rovidin p g P � m <br /> p g in th' lication. I agree to per coun officials charyyggf�l with a I s r' county inances or other <br /> authorized pe on t ave access to the above de rib premises at'd4j/ onable he pu ose of inspection. <br /> ,�t� <br /> m <br /> C m . <br /> SIGN HERE � Wd+ <br /> (sl of ow er o building contractor) slate) <br /> ZONING ADMINISTRATOR .-��Qd <br /> "I cn Fn d+v�fn vi�' <br /> N N (IINNN(T <br /> N NOCiINOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o g g g g o <br />