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Burneff Counfy 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator 0Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> m <br /> p m o0 <br /> OWNER �CJ td 1 TELEPHONE <br /> v <br /> MAILING ADDRESS D S <br /> aa 96o3 cCcrey -/lia v G r,�s u� tdo S�lb'YrJ f <br /> PROPERTY ADDRESS a'A2 3 Carey_ vt/die— <br /> Ua <br /> LEGAL DESCRIPTION(see tax receipt) o� / t ���- �� f- q <br /> /U �S/rl / j z <br /> � e <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE 'F <br /> ADDITION U� a to p <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMP/INGUNIT ❑ SUBDIVISION ❑ (n ( t <br /> STRUCTUREADDITIONUSE: O $TOr�� o �� 3U o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) co ' <br /> d <br /> BUILDING CONTRACTOR: 15 le/ � � n, <br /> Z � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY IN QRUj ILLEGIBLE PLOT PLANS WILL BE RETURNED. 5P// �6 Cl h O 3 <br /> ID p y p <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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)OF �i z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <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. o Q� <br /> 0 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. `J\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY fD <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential <br /> 6, garage/storage only. Not to be used for human M W "0 m n o m <br /> habitation. CD 'D c N ' o <br /> 7. Z v, CODo <br /> Z! <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n C <br /> all information contained in this application(including any accompanying schedule)and 11-further declare that I recognize m� L' m <br /> that this information I am providing will be relied upon by the Co u o o i d rmining whether to is- fD ` 0 <br /> sue a permit. I further accept all liability which may be a result � o f r r �ithis information I am ; m `• <br /> providing in this application. I agree to permit county offici '� iI , a C, ter ordinances or other <br /> authorized person to have access to the above described pre �aTfany reasonable time for th p rpose of inspection. m-3 s <br /> OCT Z CD <br /> SIGN HERE �� Zl� O� <br /> (sign of wner or buildingc tract ) (date) <br /> ZONING ADMINISTRATOR �� �� MTT COUNTY <br /> fA' 63 EA fo N <br /> �n' qq UN VN tNl 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEC <br />