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,amett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> m O <br /> N <br /> C <br /> n Q <br /> OWNER //( TELEPHON(7is <br /> r,7.,3-7 <br /> ,7.3-71 <br /> HOME ADDRESS (foanyu 9QO-cl L.,, � Y Tp OV o <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER 3�3 ROAD NAME C LA,n ►N PJ, )- 1 <br /> L o f 3 0 Su-v ey /ykP A 3a 66 <br /> LEGAL-DESCRIPTION (see tax receipt)6. scc +'oA /9 -7o-w,",je 410I✓AaAle I7Wd a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY � 0. ) c <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> '' � yy /I in <br /> STRUCTURE/ADDITION USE: 6Rral11 e/ WOrkc,4ap D <br /> Home/Cabin; Commercial usiness; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: L (1� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> irl y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n �r <br /> ,n O v� 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 <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CD <br /> m B <br /> 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. <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. N <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN I <br /> NEEDED. <br /> �S <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 O <br /> 3 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (l�J <br /> SETBACK AREA. <br /> s. � r5- This structure to be used as private residential X -U v v> o a o v <br /> 6. garage/storage only. Not to be used for human O < 3 a " ; a "_ ;am <br /> -o' o <br /> N 3 <br /> habitation. Z N o ' -I <br /> 7. o : E n ' m <br /> _ cn: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n o. A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `D m 0 <br /> that this information I am providing will be relied upon b the C n of B nett Wisconsin in determining whether to is- <br /> formation 9 P Y ou tY 9 <br /> sue a permit. I further accept all liability which may be a result ofliF�N <br /> n�bfBiurp i�rg qn this in I am D <br /> providing in this application. I agree to permit county officials �1r&d',�! dtgifl�s II rdinances or other <br /> authorized person to have access to the above described premis aatiy7easonableti fdt�ei ut ose of inspection. m <br /> 11 m ! <br /> SIGN HERE A-A <br /> L aul J/ <br /> (signature of or building contras (date) <br /> ZONING ADMINISTRATOR <br /> ZUNING <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 gJrO <br />