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Burner:County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c� z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> ^. 0 Y <br /> 41 <br /> C <br /> OWNER OC.('r--c- \ W TELEPHONE /Isn <br /> < <br /> HOME ADDRESS 3 `D <br /> EMERGENCY/FIRE NUMBER ROAD NAME ll 4r, f <br /> �� / <br /> LEGAL DESCRIPTION(see tax receipt) JES 1/V <br /> 0 <br /> DWELLING/BUILDING IQ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cl) oma' <br /> TYPE OF PERMIT(S): r3 U <br /> C D <br /> FILLING/GRADING ❑ CAMU,NIT ❑ SUBDIVISIONq <br /> - <br /> STRUCTURE/ADDITION USE: ) / X -' 0 �. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. J <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T C <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <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)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o If <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN '" 0 Q , <br /> NEEDED. (t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: C` <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. 11f] <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M 'A= *0CoIm <br /> Im <br /> 6. 2 � ELMxo- ;u <br /> _ m C m . <br /> 7. CMD 7 <br /> o <br /> ly : <br /> 1 declare that this application (including any accompanying sch een examined by me and to the best of my �j c p <br /> knowledge and belief it is true,correct and complete. I ackn w I onsible for the detail and accuracy of Q ii 0 c <br /> all information contained in this application(including any a panyi ) I further declare that I recognize 0 CD m m <br /> that this information I am providing will be relied upon by t ounty of Bu determining whether to is- p <br /> sue a permit. I further accept all liability which may be a re of th my of r r � on this information I am m <br /> providing in this application. I agree to permit county officials cha�r1f�+ administ unty ordinances or other 0 <br /> authorized person to have access to the above described pre at any r6A4&4W2 time r e purpose of inspection. m <br /> F m <br /> CD <br /> SIGN HERE U- do <br /> (sIgndture40owner or ild' c n cto N � ate) i <br /> ZONING ADMINISTRATOR <br /> fA(n fA fn(n!n <br /> N N f T N N 01 t T <br /> " 000000 <br /> 0 0 0 0 <br /> TOWNSVIPPERMITS MAY BE REQUIRED 0 0 <br />