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�,�-ff 'n_11D <br /> -Hurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER , x,�� � 2� / tc S rt�� / TELEPHONE 71S� __ f�� O CL `� <br /> HOME ADDRESS 7Cjc / 1 /QS�eG7G �4��. ,��.4N� s'!llrJ�� r 0 <br /> EMERGENCY/FIRE NUMBER �Cl ROAD NAME {�� � —F <br /> LEGAL DESCRIPTION (see tax receipt) m rT�) <br /> 1 DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1-1ADDITION PRIW El y 0 <br /> � 4 1_ <br /> TYPE OF PERMIT(S): <br /> Or <br /> FILLING/GRADING ❑ CAMPING UNITE] SU <br /> BDIVISIO <br /> N El 5 <br /> STRUCTURE/ADDITION USE: ,L✓✓/ ,/`clZ�M / r[�E�h 0 <br /> (Home/Cabi <br /> rercal <br /> / Business; Bedroom <br /> ; Deck;etc.) w <br /> / <br /> BUILDING CONTRACTOR: <br /> C <br /> � � 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> o � <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 c <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <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 <br /> CONDITIONS OF PERMIT: P <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. all Pj&+t0e&6 l/V dq"40 oac'/ 6 & <br /> M. <br /> 6411km m <br /> a mCWW <br /> 7. Zy � <br /> 719 <br /> 0 ' <br /> —Cn. 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 d <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- O <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 application. I agree to rmit county officials charged with administering county ordinances or other (D <br /> authorized pe ave access to t a ove des ed emises at any reasonable time for the purpose of inspection. m ? ': <br /> m : <br /> —7 m <br /> SIGN HERE <br /> ( a re of owner r ull g contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N NUI NN NUI <br /> V t V t O V t N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />