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Buhiett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �� o <br /> APPLICATION FOR LAND USE PERMITS 3. T <br /> dELL (oft. 3(09 - IIS N 0 <br /> CD <br /> OWNERPA,L TELEPHONE 7/S- $`(,- s� 9/ n <br /> o <br /> m <br /> �^ 7 33S DEE14;o !,.Av CD <br /> HOME ADDRESS 7.2 & � F26M s f6 o t2.0 -:rNVEAL Et,Eo VC #15 lyln� 0 <br /> >r <br /> EMERGENCY/FIRE NUMBER —72—8 s' ROAD NAME ( <br /> LEGAL DESCRIPTION(see tax receipt) QA K Ado 56a-e -5 5 T / rJ Lf[ ( p o <br /> ° <br /> DWELLING/BUILDING 1:1 �q GARAGE/ACCESSORY STRUCTURE ADDITION � PRIW ❑ ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> ���JJ ^ Jr5. <br /> STRUCTURE/ADDITIONUSEW �kl)t/7 471 m� � + 1'2 r x �(OI SACp i&/-Ia�M&IJJ ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: EVAE0 /f-pu5E&lO✓&?tS Arno Jykx :j:-Ai cE C0A54-RVc-h-znJ '-lir <br /> vv A-6 AulUE zap 41vo <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. / Q/ N pc--R AVC C) y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ovi M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). ca 0 <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. P <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. r1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �+ ii <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. 0 0 <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( r, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^ - I l l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LP <br /> /�J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> � v , <br /> 5. Ga_ (� j� I 1� J� <br /> J 'f <br /> U t �fY/�►>t�_J ,Dpi Ta I ` FJQ$ehI �If'Cil� 4 .Lr � ' 3 3 9 c m <br /> 6. In m. a m �c o= A <br /> N C 0 N ° <br /> 7. z : : : 1 <br /> _ �, : z <br /> M <br /> I declare that this applicAtion (including any accompanying schedule as been examineb42L me and to the bes o <br /> knowledge and belief it is true,correct and complete. I acknowled " <br /> 'amible for the detail and accuracy of o <br /> all information contained in this application(including any acd I further declare that I recognize ti m m : . m <br /> that this information I am providing will be relied upon by th untnsin in determining whether to is- '. m v <br /> sue a permit. I further accept all liability which may be a re of ttt relying on this information I am d <br /> providing in this application. I agree to permit county offic Is chacounty ordinances or otherauthorized person to have s tothe ab ve des bed p isesthe for the purpose of inspection. m <br /> A CD <br /> CD <br /> SIGN HERE �Y `� J -V `� 69 <br /> I ature o r Idi contra ,^t-- C (date) <br /> ZONING ADMINISTRATOR Y� � <br /> QLI N u o oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED o f o o alalo o <br />