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1rne#COurity 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> V, O <br /> ,n m <br /> r �OL# 4S C C C%15 TELEPHONE �l "6 5`�" <br /> `J <br /> HG.. 2ADDRESS k4 pPpan . � Z_ <br /> o � <br /> EMERGENCY/FIRE NUMBER ��Li'A ROAD NAME <br /> 1 o'f 3 C 5M an l l� Aa �l Q <br /> LEGAL DESCRIPTION(see tax receipt) 7l� ( au t` ��3 m <br /> 0 <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE t9 ADDITION ❑ PRIVY ❑ 0 � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> lax o ,��z /�d�r az. z 5: <br /> T <br /> STRUCTURE/ADDITION USE: Ali 0 <br /> (Home/Cabin; Commercial Busin s; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: st <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 33_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O �^ <br /> In 0. <br /> :9 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> P <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. �J o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS,ROADS,LAKE,LOT LINES. t ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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. (0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 0 <br /> 1. <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 Q <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. Q 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. pp � y � 1 �- t- <br /> 5. c�7irGc�Cc�e rV U l �ZJ � ���rP// <br /> � �Qti � Lc. / v <br /> nl 3. 3 ;0 n a F m <br /> 6. lvc) 4_IVL i &j t1A'#--�3 30.N N F,fd ;a <br /> (/ a% v : CDC > > 3 <br /> el 0 m 1 <br /> 7. O -A <br /> y i E m <br /> I declare that this application (including any accompanying sc ule)Mwen ex i Py,me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. I acknowl that rr`responsi 'fgr the detail and accuracy of ? n <br /> all information contained in this application(including any accomp sched�Jle and I f r declare that I recognize m m <br /> M <br /> that this information I am providing will be relied upon by the County I; Knett sinZlermining whether to is-sue a permit. I further accept all liability which may be a result of n fBu ren this information I am <br /> providing in this application. I agree to permit county officials ct inisterInty ordinances or other mauthorized person to have access to the above described premises at any o tin purpose of inspection. -n <br /> m : <br /> CD : <br /> SIGN HERE <br /> signatu of owner i g contractor) (date) <br /> 49 <br /> ZONING ADMINISTRATOR <br /> ` 69 40 <br /> N NUt NN NNOOI <br /> V1 (T OVIN 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 0 0 <br />