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Burne6-County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ciz <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> CD <br /> y O <br /> / QW <br /> . � TELEPHONF / / 3 71OWNER3S-- 7 <br /> O <br /> HOME ADDRESS 03 ctn 9 <br /> r/��f'asecal laC�tt�dn is ,303 C'au.f <br /> EMERGENCY/FIRE NUMBER 3031 ROAD NAME <br /> i <br /> I \ � <br /> LEGAL DESCRIPTION (see tax receipt) m <br /> 0 <br /> a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> Re r)o d2 a00(a <br /> STRUCTURE/ADDITION USE: gg Ad 7a X ;ZO eke•ck — /–a tr,i . &at i'o lra Ilte r fir (�I <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) tr <br /> C <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ( �trna,'� n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. cc 4(y 9 an f� z H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0In n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH (N). rA o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO IM I L) a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v z <br /> 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 BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <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 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. _ <br /> 5. ; 1 J <br /> CD co m <br /> 6. fp6 �mamoca 10 <br /> ri v cv y o 3 <br /> a om 0 O O <br /> Z : m < <br /> 7. JUN <br /> p zily: M <br /> m <br /> I declare that this application (including any accompanying sc ) has been exa i mei to the best of my 6j c C <br /> knowledge and belief it is true,correct and complete. I acknowledge o�n�sibl�e`�f�o.r the gtail and accuracy ofmri a <br /> all information contained in this application(including any accompan y =l 11) t1Y declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Bur �y/!gym m d termining whether to is- m O <br /> sue a permit. I further accept all liability which may be a result of the County of Burne relying on this information I am Q, <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m <br /> SIGN HERE <br /> (si afar ofownerorbul contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> N N O N u <br /> UUt O Vt O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br /> 00000 0 <br />