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Burn .A County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administra or 0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 5 O <br /> C <br /> N <br /> OWNER �rr� S �yr TELEPHONE <br /> :? 0 pC� <br /> HOME ADDRESS .266 l`i a <br /> EMERGENCY/FIRE NUMBER a6 Jc, I Lt ROAD NAME /L0 <br /> 1p <br /> LEGAL DESCRIPTION(see tax receipt °f 2$_�� N �( Ctg (crfd <br /> DWELLING/13I/ACCESS Y STRUCT EAI ADDITION ❑ PRIVY ❑ �j <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: Jd.1f <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> fit <br /> BUILDING CONTRACTOR: i!'� `t `��`� � ` <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEG E3T-PLANS <br /> WL BE RETURNED. 0 N <br /> _ , <br /> DIRECTIONS FOR PLOT PLAN DRAWI\N�a (AERIAL OR TOP VIEW) n ii <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In cQ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. r`/ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �. c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g ° p , <br /> NEEDED. <br /> Z Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P .S <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. -A A <br /> �Q� aHd ?hih�&Ctu�to be used as private residential 2 3 CL �e � <br /> 6. garage/storage only. Not to be used for human -6 m m o H g 3 <br /> habitation7. . 0 : i �0, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 m responsible for the detail and accuracy of \ : : - <br /> all information contained in this application(including any accompanying s hetendfurther declare that I recognize m <br /> in determinin whether to is- <br /> that this information I am providing will be relied upon by the County of B n sue a permit. I further accept all liability which may be a result of the Co n this information I am ? Uproviding in this application. I agree to permit county officials charged ac ances or other m <br /> authorized person to have access to the above described premises at an r sonable tim a pection. - <br /> CDCD <br /> pea � � . _ lb. <br /> SIGN HERE [ <br /> (signature of r Id' or A,C� <br /> 'YC <br /> ZONING ADMINISTRATOR ,N +A f^r^ d"^ <br /> G N N (1 NNv, in <br /> fT UtO (l, UtOO <br /> 0 0 0 0 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED <br />