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c lc m <br /> $urnetYCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> N O <br /> C <br /> OWNER �a$Q, Zit4AQf�_ TELEPHONE G p <br /> HOMEADDRESS A4CtL� ���v'� r <br /> EMERGENCY/FIRE NUMBER ROAD NAME n <br /> / <br /> LEGAL DESCRIPTION (see tax receipt) /� —/� �� (9 / /�[����I�W G <br /> G <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITI N ❑ PRIVY ❑ C <br /> TYPE OF PERMIT(S): Lot-/- 521 <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION / r / S. <br /> CS <br /> STRUCTURE/ADDITION USE: rny /J <br /> (Home/Cabin; Commercial Business; Bedroom, Deck,etc.) Cl) <br /> Er <br /> BUILDING CONTRACTOR: 5z����//� <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. j N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> c <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. \alt <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 �. 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g ° <br /> NEEDED. 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 I l� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^J <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. A -a mm tOo �5q <br /> (m n <br /> C H <br /> 6. N m o <br /> W <br /> 7. ^,; _v, : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my W C c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m . <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> m : <br /> 4L4 : <br /> SIGN HERE (date) <br /> (sign re of owner or building ontractor)_ <br /> M <br /> ZONING ADMINISTRATOR <br /> N N O (NJ1 fr O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />