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8urlhett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 office of Zoning Administrator 4 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N <br /> CL <br /> p / C <br /> OWNER I/ /t/�i1 C �6 S I'/ !r✓6TELEPHONE l0 �O 3,2 - p �1 <br /> `° oO <br /> HOME ADDRESS ///we IkA CZOM) -XZZ 076 9 9 <br /> EMERGENCY/FIRE NUMBER 2 ROAD NAME 06 `,/</ /'ft' ' /'70 X <br /> Y <br /> ( w <br /> T <br /> LEGAL SCRI TIGON(see tax receipt) / S f 2l 5�e/ka-1 - W /7` Ste% ��7'3 C <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY 11c <br /> cr <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPIN UNIT ❑ SUBDIVISION ❑ 5 <br /> 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) C I2. <br /> ` l <br /> �S [�BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 13()' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �,vt i r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) — ���(,/ .{� T CL d <br /> .7- LJ T ?� O Z <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(N AND INDICATE C c <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO � ��.., 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Vi' 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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2. <br /> MUST i <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN C ° <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Q <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.. d 0�- At/ e / y �e <br /> 5. LUI.s �t° 0/!7 / / /7F�`� / �.,lJ �I�- v_ 0 r v v m <br /> m <br /> � <br /> o <br /> 7. =_m: rn <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ~ ZS c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <br /> be a result of the County of Burnett relying on this information I am <br /> sue a permit. I further accept all liability which may E d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -CD <br /> : <br /> C5 : <br /> SIGN HERE (date) <br /> g lure o er or building contra <br /> 40 <br /> ZONING ADMINISTRATOR 11^'^'A 40 d' <br /> N N V, NN01 <br /> ri ri O (T V,0P0 P <br /> lc�O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />