Laserfiche WebLink
Bupnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 11 <br /> C <br /> OWNER aJoo IL ri*� '!,19A)I I TELEPHONE G 5'3 <br /> HOME ADDRESS ,�3Q5� OLD 36'_ .5(Re4d gob <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER �,4,iij fp� ROAD NAME <br /> f o Gnv for/— <br /> LEGAL DESCRIPTION(see tax receipt) (_' $/K !/�7 /�j�r33�3 8'9, CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): ) ii <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °_' <br /> STRUCTURE/ADDITION USE: S7--A/QS TO i_*XE. (13 P, Mlbw! Semft 0 <br /> (Home/Cabin; Commercial Busine s; Bedroom, Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: SELF <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m CcJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 �p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �° <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. tZ <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. ,o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT , J <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. d/ <br /> ;o v0 r.- p �o0 <br /> 7. 1< <br /> = cl' : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of p, o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0% m m : m <br /> that this information I am providing will be relied upon by the County of i whether to is- I1 y m O <br /> sue a permit. I further accept all liability which may be a result of the C B r 11 information I am V d <br /> providing in this application. I agree to permit county officials charge' wI a n ances or other m E <br /> authorized person to have access to the above described premises at ah reasonable time for the pur o of inspection. T <br /> P. 2ICD <br /> SIGN HEREAll <br /> _ <br /> (signatur ow e r co ractor) "�+pNE�C 169 <br /> O e) <br /> ZONING ADMINISTRATOR rl N•'•Y 44 49 40 ' d+ <br /> N N fn N N N ut <br /> V7 VIO V7 C11OO <br /> OWNSHIP PERMITS MAY BE REQUIRED o o o o 0 o m <br />