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z <br /> Bumett Gmxty 7410 Camsity Road K, No. 102, Siren,WI 54872 Ofte of Zm*v Adn*ds ator ¢ <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER t t CZ r S TELEPHONEJUJ'GSJ� p �} <br /> MAILING ADDRESS <br /> d.0 Box 57q &, re ti, 9 <br /> PROPERTY ADDRESS �/ 7 r P e ti i �{ e b s e r Gl)i 5 1 C/3 m �I , l� <br /> LEGALDESCRIPTION A AT CF (c'0f L 400 UTI cs M v i a Pa 5 c ��,�y 9 q,1 '0 79s,P 4. a I� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING® ADDITION® DECK® GARAGEIACCESSORY STRUCTURE I.. g <br /> BUNKHOUSE® 59.692(1V)GAZEBO ® STAIRS® FILLING/GRADING ® CAMPING UNIT <br /> COMMERCIAL BUILDING® COMMERCIAL ADDITION ® COMMERCIAL ACCESSORY STRUCTURE ® <br /> STRUCTURE/ADDITION USE: T L4 r L T» �• a <br /> (Home/Cabin;Comrnerual Business Bedroom; Deck; etc-) <br /> BUILDING CONTRACTOR: II„ <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INOOPWLETE OR n i EGIB F PLOT PLANSar <br /> � <br /> WILL BE RETURNED. <br /> XRECIIONS FOR PLOT PLAN DRAWING: (ARIAL OR TDP VIEW) e=i II 00 <br /> ALL REOUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. "' G <br /> _- SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> -ULDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, -n <br /> AND INDICATE NORTH(N). 6 u <br /> G <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINS) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENr(S)TO THE ORDINARY HIGH WATER MARK pp <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. IQ'J <br /> 4. SHOW THE LOCATION OF THE WELL(N),SEPTIC TANK(ST)AND DRAINFIELD(DT),AND ALL DISTANCES 1 <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. (,ll I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. —'Z <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER- Of 1 <br /> NOTE: BUILDINGISIRUCNIRE LOCATIONS MIST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHET <br /> THIS PERM rr IS SUBJECT TO ALL CONDITIONS LISTED BELOW: \\ <br /> I_ DRIVETVAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHOREUWD ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA- <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION- <br /> 6. <br /> 7 <br /> I dadare Hal H"s appiul6m(Ns�9 r1 acommPryfmg ssbeile)bas horw enaied by me amd to He best d mry 3 ® .7 �.2,.'a °'"�'^° In <br /> browkdgm and bafaf it-s true eoerett sed sornolde I adnowNdya Hat I awn reepowwlle for He debt and accuracy of al <br /> iforrr0om contained n Ha appicatba Cog my a3edad)mad I fudb r demre Hat I Hat His <br /> iferrnadoe I am providing win be relied upon by**Camty of BmrQ 110 Y detvmiip wbetbar to®re a pamuL I iL <br /> m m 5= = II <br /> fmrtbar soup[al 6bift Hat my be a raert of Hw Comaty of Buren rdh as Etc Feforrriom I am peov1- inthis <br /> appia0em. I agree to Psmi rorty aN ak staged wB adr iirtrabtg cammW ordinances ar dber aaHorel paeom M have 6 <br /> m <br /> aauu to He above-deaoMd Morias at aY rrHa <br /> ammatle ne far He ppmsa d im <br /> speoa- s ®� c ` <br /> tib <br /> OWNERS SIGV1►IURE Q �a� �R-�' nn ip 0 ==c 5�F- <br /> elowul LL2u <br /> ini 2:OMIINGADM@OSntATOR a r-- <br /> �" a <br /> Lt <br /> TOWNSHIP PERMITS MAY BE REWR® pp����pp -" <br /> THIS PFRMTT SHAT I FXPIRF ONF YEAR FROM I)ATF OF l��lf COUNTY <br /> ZONING <br />