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SSurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O0 <br /> N <br /> C <br /> /�� r1 r d <br /> OWNER ! " ` 'P�f V/ TELEPHONE���.S�a + /g�Q cc <br /> HOME ADDRESS ,s'i 2 r vrc't J sf. /hOLS rhN, Z� o <br /> EMERGENCY/FIRE NUMBER ROAD NAME PvnA1 'fa/a & <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) 1L Ut �Sm `+ `V I Gov' `- t ` m <br /> V <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ N °c <br /> c M <br /> TYPE OF PERMIT(S): Cr <br /> CL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ^ N: <br /> STRUCTURE/ADDITION USE: <br /> Home/Cab ; Commercial Business; Bedroom;Deck;etc.) m <br /> 2 <br /> BUILDING CONTRACTOR: lir <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 33_ Z <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 -W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m n 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 /> S. 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 0, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P, l� <br /> CONDITIONS OF PERMIT: <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. -To �Tr 0 = o0id M �OCL m <br /> / D_ N O O 3 <br /> 6. N C U <br /> N N O O <br /> CD <br /> 7. O _ N : <br /> m <br /> I declare that this application (including any accompanying s e x y me and to the best of my G) C <br /> knowledge and belief it is true,correct and complete. I ac ledge that p i or the detail and accuracy of o E* <br /> all information contained in this application(including any, ompap schedule)an r declare that I recognize ©: ' `" p m <br /> that this information I am providing will be relied upon by t Coun�urnejtNiscinsin i determining whether to is- d <br /> sue a permit. I further accept all liability which may be a result of the County bftt rel on this information I am <br /> providing in this application. I agree to permit county ofr �(� with aderin unty ordinances or other m <br /> authorized person to have access to the above described or <br /> 9Q ble time or the purpose of inspection. m <br /> ONlN '° <br /> G ,S= <br /> SIGN HERE 2 9—v0 <br /> (signature ofr or ding contractor) (date) <br /> ZONING ADMINISTRATOR \J I I YI r � 4 <br /> K) N En »d+fn un <br /> N NO� NN01 VI <br /> This structure to be used as private residential v, v o Cn 0 0 <br /> TOWNSHIP PE garage/storage only. Not to be used for human <br /> 0000000 <br /> habitation. <br />