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BViiett ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS � � 3. <br /> IIIN r- <br /> 5�o <br /> OWNER LEAaouR �[,/S:$' TELEPHONE 636-- 797,P o a <br /> HOME ADDRESS <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER /3X ROAD NAME 15%9,CRr,5- / ~ <br /> LEGAL DESCRIPTION (see tax receipt) F L V Pkv l U - t N <br /> m <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTUR ADDITION El PRIVY El1 Or <br /> TYPE OF PERMIT(S): a F <br /> ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: Gi L A o' <br /> ��QQ ,p(Home/ bin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: //d� . d4GoyC to <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF O �Z <br /> LAKE,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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. P <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N t\ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o T <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 F ETAINI G WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. U <br /> 5. <br /> I K ter O Orn <br /> This structure to be used as private residential � a mz <br /> 6 -5 garage/storage only. Not to be used for human : V N o' <br /> habitation. 2 : y 07. : ° ° 3 <br /> o : <br /> y: x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknow hat I am responsible for the detail and accuracy of d c <br /> all information contained in this application(including any a ��Fo;, ryy{���eee and I further declare that I recognize m <br /> that this information I am providing will be relied upon by t my Y�� � in-4n determining whether to is- <br /> 4 O <br /> r*I <br /> hg a permit. I further accept all liability which may be a re of the�erSrrtof, u eyrhg_ this information I am m E <br /> providing in this application. I agree to permit county offs I charged with ar�mi e�pupty ordinances or other m <br /> authorized person to have access to the above described p ises at o able time for Ahw purpose of inspection. m <br /> SIGN HERE <br /> (signature of n or building contractor ! CQU,V (date) <br /> : <br /> ZONING ADMINISTRATOR 6' <br /> N (Ji Vt O <br /> TOWNSHIP PERMITS MAY BE REQ'U'F4 <br /> 6q��� <br />