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13urne3 County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> Q <br /> �V <br /> y O <br /> N <br /> C <br /> �' <br /> OWNER �.��/�ZE�YGE �. TELEPHONE <br /> m <br /> CD <br /> HOME ADDRESS / <br /> �/7� Sl�,vFLt2u/��✓� G'�.t"c-LE S/ �i4� G /��lr( X27 <br /> EMERGENCY/FIRE NUMBER / ROAD NAME <br /> e <br /> LEGAL DESCRIPTION(see tax receipt) ��-O��_2 -����d•-(� �!Zod �O'��%/ 1 m p, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn 5 <br /> c <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o: <br /> STRUCTURE/ADDITION USE kBa�o/c � /2L�//•Tff C/� /!2S �t?&AaC /70Kqt= (� , <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> m <br /> BUILDING CONTRACTOR: 2. <br /> 4 4, 4,4. <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> In o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ((�3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v ) <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. C� 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. \ ((( �1 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ; 0 /J�IJ' <br /> MUST BE SIGNED AND DATED BY THE OWNER. oi <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 L1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z XJ <br /> CONDITIONS OF PERMIT: 0(} <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 'V <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. XJ I F <br /> 5. STRUCTURES, LUDInRETAINING LLC.,ALLOWED HIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> ;U n r D O D OM <br /> f m <br /> 6. mo a D x m 0 <br /> -o � cy !^ o � 3 <br /> 7. <br /> o 1 <br /> o <br /> = � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true, correct and complete. I acknowl a that I am responsible for the detail and accuracy of \ m <br /> all information contained in this application(including any acco CL <br /> schedule)and I further declare that I recognize �JO O <br /> that this information I am providing will be relied upon by the C Isconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a resul n relying on this information I am : <br /> providing in this application. I a o permit county offici harged 1 s r' t ordinances or other o <br /> authorized person to c to e a ve described re s at an reaso t f CD P P y p pose of inspection. m : <br /> APR <br /> SIGN HEREIZZI" a <br /> (signature o own or ' <br /> building contrac U� (tl e) <br /> ZONING ADMINISTRATOR <br /> J.1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �qG <br />