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7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITSrt 3 <br /> r <br /> OWNEk � ' n � �rt,��E TELEPHONE 12— ��yJ� —��,�7 a <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS M YW10co <br /> LEGAL DESCRIPTION(see tax receipt) f GL Lrx� LaT 2 I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION SCI <br /> TYPE OF PERMIT(S): 9 lb <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE 'J S �S w� iE��(� —I x In <br /> (Home/Cabin; Commercial Business;Bedro m; Deck;etc.) d <br /> BUILDING CONTRACTOR: m <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fA o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. ° <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. N Uj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 Sul <br /> MUST BE SIGNED AND DATED BY THE OWNER. o a <br /> o (JC <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC11�Q J�Y� DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. V o <br /> CONDITIONS OF PERMIT: Val <br /> JUIy F� 2u � d <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF X R IT 2003 .� <br /> ISSUANCE. Cf p rr ••`` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL r G+ W q <br /> 3 NO GRADING <br /> ED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY o C u/v y a <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /�� -d 7_//_�/ 3 �J <br /> 5. . . n,,^ / ! , <br /> d�Ll7 e'r � Q��1�' 0 ,ronDoM <br /> 6. 3 00 00 COL. M <br /> v mc0" o 3 <br /> 0M 0 - 20 1 <br /> 7. o l� m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <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 m O : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 o <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. m s <br /> -n 0 : <br /> CD <br /> � iu <br /> SIGN HERE a <br /> (signal of owner or buildin ontractor) date) <br /> ZONING ADMINISTRATOR <»v+ <br /> (A<A dl W0 N <br /> 0 N N 0 0 <br /> to <br /> V10(T (r 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED .� <br />