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;ounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 11 u o 0 <br /> APPLICATION FOR — LAND USE — PERMITS w o <br /> DNING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -0 m <br /> s shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 g <br /> 3urnet, r Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. °= <br /> w m <br /> m O <br /> a £ <br /> JWNER i <br /> Lee /'I a rs ti s 11 TELEPHONE G0� g.? - 33 7 m <br /> 4- <br /> RESS , fh ilei Sl1 eat rossE 1 s`i �D <br /> �J 9 <br />=MERGENCY/FIRE NUMBER 9 9,U /1 ROAD NAME Cry N <br /> S lwcl ` <br /> LEGAL DESCRIPTION (see tax receipt)Gov,t Loty �A f.oZ. S. b�Ar•s l'w'� r'�L,�-s 1,.5/y` �o�. �P��V -yl —� <br /> CONTRACTOR okonak st, fl. 6,y. -f69 .S c•mNr AM,.e G33= 73x1 (J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 G) r <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION 0 °- ni <br /> J /� y i D <br /> STRUCTURE/ADDITION USE: at /Sd NtO/(ra.bti lra/'4-�6 -{o be adi4e'd 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o kA <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). � <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O p <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O <br /> dated by the owner. 0 ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 <br /> PLOT PLAN o <br /> e1 <br /> L rtie N f <br /> `� • Ra♦e'cT" III <br /> IKar-St. <br /> I <br /> µh [I t <br /> VIII 0 <br /> O SI I�ukN <br /> N <br /> W <br /> H4b•+ pr•/.a tr r � � <br /> O I <br /> 3ax3.2 <br /> x 32, �� 1�ariance� m <br /> Peel <br /> a n <br /> a t-n Z <br /> D <br /> 1 <br /> I <br /> E---- r s'> � 1 <br /> TOr•.� I <br /> !u' c.pr 4rXi1 ' S�olaye SkG+ R 0n 4v <br /> Imo <br /> dee g . ; <br /> CONDITIONS OF PERMIT: fk„ <br /> d ce L.-ne Z 2 , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WI H REQUIREMENTS WITHIN 60 D YS O PERMIT ISSUANCE. r c ! N <br /> 2. REMOVAL OR CUTTING OF TREES AN VEGETATION IS RESTRICTED AL N SHORELINE. mm <br /> 3. NO GRADING OR SHORELAND ALTERA IONS ARE ALLOWED UNLESS SP FICALLY PERMITTED. <br /> g C <br /> I declare that this application(including any companying schedule)has b mined by me and to the Vest of my knowl o i <br /> edge and belief t is true,correct and comple .I acknowledge that I a ib for the detail and accuracy of all informs m T <br /> tion contained iithis application(including any accompanying edule)a I fu er declare that 1 recognize that this infor- g 8 D <br /> mation I am providing will be relied upon by the County of Bur tt Wisco sin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a res It of the County of rnett r ng on his information I am providing in Chia ap- <br /> plicatlon.1 agree to permit county officials c of with Zininist ng.cpunty_ordi noes or other authorized person to have <br /> access to the above described premises at ny reasonable time for the purpose of napection. T $ <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) i <br /> ZONING ADMINISTRATOR <br /> o �� iSN � N'S5 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ $$ $8 <br /> 88 i$ w <br />