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Bumex County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS a F- <br /> OWNER TELEPHONE <br /> EA <br /> I< 61��63—YY83 9 <br /> MAILING ADDRESS S <br /> PROPERTY ADDRESS O <br /> a `L,3 9 , c a. R.1._d—T ,Jr.,,6�..yTdl�• .�83� � <br /> LEGAL DESCRIPTION S '1 <br /> PCa Gov LOT 4 of SG7f <br /> TYPE OF PERMR(6): SINGLE-FAMILY DWELLING ❑ AODIT[ON ❑ DECKECKE]❑ o GARAGE/ACCESSORY STRUCN0.E JI( 5 <br /> BUNKHOUSE O 59.692(SV)GAZEBO 0 STAIRS O FILLING/GRADING O CAMPING UNIT E) <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE 0 � ✓� <br /> STRUCTURE/ADDITION USE: 5 fo t e.%C a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: — v Q 1 <br /> A PLOT PUN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> _ <br /> WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW m <br /> BUILDINGS/STRUCTURES (NB3), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). n \ a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) ) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. w O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD(OF),AND ALL DISTANCES u <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. ' INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I7,j y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE rn <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (j� PI y <br /> ' 'NEEDED. <br /> THIS PERMIT IS SUWECr TO ALL CONDITIONS LISTED BELOW: r y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F t IHUy, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. ^' a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C� <br /> - <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. M1� <br /> NOT TO BE USED FOR HUMAN HABITATION, rV� <br /> 6. SYru�.�iA.-'tZ,u� �/,� �i'Or) `'R O W IZ'tG .a f <br /> 7. <br /> � pannn a'Jp <br /> F 'n ,RN333 �� m <br /> I declare Nat Nlf apMKatlon(lncludl % 6 A 7. A <br /> nq am a®laba. I ac no duke Ms been remlreG a Lund N Me bet ur my o ,2 _ ,z. .1 ?a <br /> knoale do arta tbeelf akecR k true,mmeR and odinipta. 1 admoMnlpe Nn I am rend!I fibk M the Mall and accuracy a all <br /> Inkrmed-I lan aray ,In Nk apbRutled uban by t e C a my of yVy srMluk)and!I NNe declare Net I r0Z9nitt Nat Nis 8 `a n ¢N > <br /> IMarmatlon 1 am prwtlirg x111 de reld open Iry the fiurM ar Bumnd Wlsca rs In determm4p.aeNar N I a pnm1L 1 _ Raw'= <br /> fuH anzpt all IkMley Nat may be a,cwe of Ne County N Mimed naynV an Nis IMnmaEan 1 am prwkeq M NM �Pe ' = t^'^ -d <br /> apMkatan. I agree N perme munly affic ak clmr9ee a1tN allm.".11ry,county Minane,;or Mer auNo4M person In Mw <br /> a�[o Ne above-desalb4 gnnlsn e[anY�sanaEk tlme kr tM pu m d pa g$W w > <br /> OWNER'S S16MTUM AYA JA <br /> ZONING ADMINISTRATOR D ���11 � n <br /> tlTll 11 t�� % c; .pe <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS EM 15 2013 <br /> .tt-'^ w u <br /> 800 <br /> BURNM COON <br /> ZONING <br />