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Ejurnett'County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 L7z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> - r <br /> N <br /> C <br /> Q d <br /> OWNER ff6f VQ' 140 TELEPHONE 3 <br /> HOME ADDRESS l t J �' 0 <br /> C ° <br /> EMERGENCY/FIRE NUMBER 2 ROAD NAME / <br /> OLA- <br /> LEGAL <br /> wLEGAL DESCRIPTION (see tax receipt) (n <br /> (D <br /> X _z) o <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION .`,2 1/) Cn Cr <br /> VG � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> (A <br /> STRUCTURE/ADDITION USE: �� (r s <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> ;U m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> ,n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Q} <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m <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 B <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, .zv <br /> 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 BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS Oct 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. T <br /> ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zo O <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 7 F THE OHWM OF LAKES, <br /> 5 PONDS, RIVER UNLESS SCIFICALLY PE ED. <br /> /C/JCN29(I r1TPe �r�( /j � v o v <br /> / V m <br /> 6. `7 Se V m.� 'um C K <br /> �. v W <br /> C o 0 3 <br /> 7. ene„ S-ll-9'8 r� - ®�sIf ta 109A PP/ o Cn <br /> M <br /> I declare that this application (including any accbmpanying schedul ) has b n me and'to,t a bes my L7 ; p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am re Ii 7a�cc_ of <br /> all information contained in this application(including any accompanying schedule) f� `rcoghize m <br /> that this information I am providing will be relied upon by the County Of Burnett Wisco siylvn Ing whether t0.is- <br /> 4 <br /> S- O <br /> sue a permit. I further accept all liability which may be a result of the County of Bur lying on thin information I am m <br /> providing in this application. I agree to permit c my officials charged with administef g,County ordinances or other Co <br /> authorized perso h ve acc s to thea e d ribed premises at any reasonable time for, he`p rRose of inspection. r . <br /> - : <br /> m <br /> SIGN HERE <br /> (signature of ne orb II n o (date) <br /> ZONING ADMINISTRATOR cn <br /> 40 4W <br /> K) Ln " N(T N <br /> Un O C" Ln OO <br /> TOW SHIP PERMITS MAY BE REQUIRED o o <br />