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Bu!t!ett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3 r` <br /> N O <br /> N <br /> C <br /> OWNER io C/� ��S jjQ�Aj D TELEPHONE -a76<1' 7 n <br /> D <br /> p <br /> HOME ADDRESS ��j /�AN ;4FZ ?a r . 1r -j/97� 9 <br /> CD <br /> EMERGENCY/FIRE NUMBER �S$^$' ROAD NAME DAN/EL 7o l <br /> � dl- - , <br /> LEGAL DESCRIPTION(see tax receipt) lac/ G� N <br /> 0 <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE 1:1ADDITION PRIVY ❑ y 0 . <br /> TYPE OF PERMIT(S): O c� <br /> FILLING/GRADING 11CAMPING UNIT El• SUBDI ISION 1:1ry a <br /> c- /� -�� <br /> STRUCTURE/ADDITION USE: J USI /C OC7�� C� Q�Q�jYl��r t� 0 <br /> (Home/Cabin; Cernmercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: POUR p* 1 aGtMV � [JL��N�'S /FN Z tq <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n o OQ <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO to 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 31 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS N N <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENCr^ <br /> Q o <br /> N O <br /> NEEDED. ) -� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 1 <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> o� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ti <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V _ <br /> SETBACK AREA. <br /> m oWOt <br /> m <br /> 6. � 0. R- � <br /> 7. ti / /7 �-W/� J(~ N C N N j <br /> U 3 <br /> O ,ZI <br /> q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompa ing schedule)and I further declare that I recognize mm m <br /> that this information I am providing will be relied upon by the Co Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result n I ing on this information I am m <br /> providing in this application. I agree to permit county officials a Is egpnty ordinances or other m <br /> authorized person to ave access to the above described pre s at any reaso t f 1t rpose of inspection. T <br /> AU6 CD <br /> C <br /> SIGN HERE { 2 9 000 0 � DO <br /> � : <br /> (signature f ner or building co ra tjqURN (d e) S <br /> ZONING ADMINISTRATOR �-4 <br /> N N OI N N VI V7 <br /> OI u10 Uf Cn00 <br /> TO NSHIP PERMITS MAY BE REQUIRED 516 0 0 0 0 0 0 0 <br />