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ti <br /> Burnott County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> w � <br /> N <br /> C <br /> N <br /> OWNER r If G TELEPHONE�" _ G _ d 0 -�, <br /> d <br /> � <br /> JT- <br /> MAILING ADDRESS 7 / /)I �' TL <br /> O <br /> pd r4 G t�1c f_ <br /> CD <br /> stray <br /> PROPERTY ADDRESS 7 g O o Z(Z Ij n e CSa-ALurSj <br /> LEGAL DESCRIPTION(see tax receipt) q Ly `/+S�n V q 'P4 1 I LI—Llo —1 z m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE �& ADDITION ❑ m 0 <br /> TYPE OF PERMIT(S): O v <br /> FILLING/GRADING ❑ CAMPING UNIT i❑ SUBDIVISION ❑ o <br /> STRUCTURE/ADDITION USE: RO L e S h P_ C1 S rd r\ A Q if . 3 6 X �30. <br /> (H a/Cabin;Commercial Busine s;Bedroom; Mack;etc.) co <br /> Q ►, d <br /> BUILDING CONTRACTOR: .�2r'�►" �' d <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O d <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI `rWNEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. `' Z <br /> CONDITIONS OF PERMIT: J�'` p P <br /> ?DO? ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFB PVA%1kLE7-r <br /> ISSUANCE. 22nn Cw v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL&/V//VG N7'y+ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SE BACK AREv/A�.� <br /> 5. �\16C& m m ori chi O a O M <br /> 6. 3 a m Ox° m <br /> O ry C N N O 3 <br /> 7. Z moo : � c -1 <br /> M <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CDsue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. M o <br /> CD <br /> m m <br /> SIGN HERE <br /> a <br /> (sii tura of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR v 1 <br /> L <br /> 1 cNiC) o0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />