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Surnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N ° <br /> OWNERry� TELEPHONE <br /> �r k n 3 <br /> HOME ADDRESS <br /> � <br /> 735`b' Q�.,le, S� , ���5��r , �� S^ F v rn <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)G& 4f Z T`70 `Iz Sk tt/Gy �YjA y S 0Cn <br /> DWELLING/BUILDING ❑ E GARAGE/ACCESSORY STRUCTURE ADDITION 0 PRIVY ❑ m ° j <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑1 CAMPING UNIT ❑ S'UB/DIVIISION El5 ^ <br /> STRUCTURE/ADDITION USE: (?&A e-- a`l xa q ° <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: tc vlCD <br /> iu <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81Fi X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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 /> co <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq ° <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z f\ <br /> CONDITIONS OF PERMIT: P jD <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0,�okov <br /> m . d m a m <br /> 6. V N <br /> 7. p N m 7 0 <br /> m <br /> I declare that this application (including any accompanying schedule) has been ned by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I for the detail and accuracy of o IF c <br /> all information contained in this application(including any accom Is ukther declare that I recognize m m m <br /> that this information I am providing will be relied upon by t isconsl idetermining whether to is- O <br /> sue a permit. I further accept all liability which may be a t of Burnett r 1 g on this information I am m <br /> providing in this application. I agree to permit county o q rged with ateri c unty ordinances or other m <br /> authorized person to J#ve access to the above described mises at a rea time f r the purpose of inspection. T <br /> m : <br /> w\ <br /> SIGN HERE coy-" C) 464 . <br /> isi atur f owner or bui c or``� w`\N (date) <br /> ZONING ADMINISTRATOR �1 . . . . . 49 <br /> t»v+in v+to t» <br /> N NCn N N°1N <br /> Vt NONNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />