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BU aunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> f/1 <br /> OWNERS -t �C��� �.tZ TELEP NE 37p— Z.7 733Z otit <br /> HOME ADDRESCD 0 <br /> S Q �G '� r s$ <br /> m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 193,0L S� ROAD NAME 1C <br /> SC /° Tyy�o �Q 34c `fdl� 1 <br /> LEGAL DESCRIPTION (see tax receipt) 6 /4 t 3 <br /> M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY rn 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION l �- y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Comm rcial Business; Bedroom; Deck; etc.) C0F Q <br /> m <br /> BUILDING CONTRACTOR: � . <br /> v <br /> m ` <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYs X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Oy l�1 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ED <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 m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t 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 SO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z a <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. Uel <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WI,TJi 1�� <br /> SETBACK AREA. Uj Iurn <br /> 5. <br /> ��r t r] I � W M0CDaf m <br /> 6. AUG • 6 L�� m o a m �c a D <br /> "O : CD C y N Ei = 3 <br /> Z N N O7. 0 ? <br /> BURNFTT W NTv T ` z <br /> - 2 A <br /> I declare that this application (including any accompanying schedule) has been examitygd�kyl�q�and to the best of my � c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respons etail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this ap Iication. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave ss to the ve described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> m <br /> SIGN HERE <br /> taiooofow r uilding contractor) (date) G <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />