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6z c-Gyyo <br /> Burnett G aunty 7410 Co. Rd. K, '102, Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS - <br /> N <br /> ` <br /> OWNER Z O�CTELEPHONEh� 6Id �� Q�Q p <br /> HOME ADDRESS -P*'L rN r-. AtA if• Ate ROAD NAME aptf &�kP ^001' <br /> r m <br /> EMERGENCY/FIRE NUMBER 11:::111i a"11-111 <br /> o <br /> E' pa . oj�' o ' o G©�. <br /> t -7 �"Y� S Lr o 7 JL e qr w `:,yes rn <br /> LEGAL DESCRIPTION (see tax receipt) T� �Q m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ Cr <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CCAM ING UNIT ❑ SUBDIVISION ❑ N: <br /> STRUCTURE/ADDITION USE: C! Cl) <br /> 9-1 <br /> Home/ abin;�Cmmercial Business, room, Deck, etc.) <br /> BUILDING CONTRACTOR: e ti m <br /> e 1�� <br /> Oa.n.e/' CID <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> O n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Z <br /> v � <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 <br /> C n <br /> NORTH(N). to B <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. N <br /> 5. 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 �. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> p � 1 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r - <br /> NEEDED. W <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 6 <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �\ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ET LOWED WITHIN THE REQUIRED WATER <br /> SETB}\CK AREA. // <br /> 5. w !� <br /> S r m w d o� n f m <br /> Om. 30 n 2 0- <br /> c , I_ <br /> 6. pY <br /> r-64 1- o <br /> i r0P !O N � N � o <br /> Z0 �2 RAI <br /> 7. = N : O <br /> are that this application (including any accompanying schedule) has been examined by me and to the best of my G) 2 <br /> I decl : c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m :. <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> his information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> that tpermit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> sue a 'd <br /> Ilcation. I a ree to permit county officials charged with administering county ordinances or other m o <br /> providing in this app' 9 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> CD <br /> ,� 7 <br /> SIGN HERE (date) ({ <br /> (signa re of owner or building contractor) <br /> ZONING ADMINISTRATOR r� <br /> TOWNSHIP PERMITS MAY BE REQUIRED �JS� <br />