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ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - a o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> OWNER ,(j UC /"//d �/ L 'D r/Q '/P� /J TELEPHONE 713 7—ZE7� <br /> HOME ADDRESS 0 L NV ` /I /I a V M <br /> M <br /> EMERGENCY/FIRE NUMBER ROAD NAME (f7 i'6ASoi) <br /> LEGAL DESCRIPTION (see tax receipt) -�/01 \ y <br /> m <br /> c Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY c <br /> TYPE OF PERMIT(S): v U <br /> FILLING/GRADING ❑ CAMPING UNIT W SUBDIVISION ❑ �` <br /> ro' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) / m <br /> BUILDING CONTRACTOR: (n,4 p -eA roj2-&c MAV <br /> v <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 Tq <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> O c <br /> ?+ o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0' <br /> BUILDINGS,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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t W <br /> ISSUANCE. \ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (W� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER \ V <br /> SETBACK AREA. <br /> 5. <br /> r.- <br /> G In to M CL m <br /> m � 3 nm x <br /> 6. N rC C `" o 3 <br /> Z <br /> 7. o = <br /> y ' ` m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c JO <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o i� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize NCD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m l7 <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 m for the purpose of inspection. <br /> CDm <br /> SIGN HERE ' <br /> J� h00 0 <br /> ( nature of n or buildin tractor _ fyyy� (date) <br /> LU <br /> ZONING ADMINISTRATOR <br /> 3URNETT COUNTY N N Ut N N N O <br /> 0000000 <br /> TOWNSHIP RMITS MAY 4!ONWED <br />