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P" <br /> Btfrlt&tt County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> OWNER <br /> �/L L�,�'' TELEPHONE m <br /> f <br /> HOME ADDRESS - 4 � � ' -r'� - ' l� <br /> EMERGENCY/FIRE NUMBER a Ll l <br /> 9/ �R ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) RN, V G'�� �� r /�//_,,I � g-' <br /> I/V I�-r IOW o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION , PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> _ 5. ( i <br /> STRUCTURE/ADDITION USE: Lit/fit{j l�J t � 01( yr <br /> (Home/C bin; CommercialBusiness; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: 8��,j(d� J , Irj <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 A, f� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n W l j <br /> Ser? Llurlatic2 65(0 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n o. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. /1r1L1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c w <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO'AN ONSITE VERIFICATION MAYBE DONE WHENNEEDED. Cr (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ' ;7 <br /> ( � I <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. jy <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. a C/'�p� � jv <br /> 5. �b J� N�� Ott, Gt cam'K! U <br /> 6. 1 -� � ay �Q � <br /> • m C m . o S 3 <br /> 7. z y m� <br /> o <br /> _ co <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1recognize m ;11 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County rg nett relying on this information I am m <br /> providing in this applicatio I agree to permit county officials charged with%actfii ardinances or other ? m E E <br /> authorized person to hav ac ess the above escri bed premises at 'nyre, hI rose of inspection. T : , <br /> /y iD i <br /> X <br /> SIGN HEREC7 <br /> (sig ure of owner or bui in contractor) 12 I I alate) <br /> ZONING ADMINISTRATOR IYL�' Q' ° <br /> UNIY <br /> �v+v.tncnv+w`� <br /> N N(rNNGn Ut <br /> ZING � �o� Noo <br /> TOWNSHIP PERMITS MAY BE REQUI 0 0 0 0 0 0 0 <br />