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Lc Yr .p <br /> Buetett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis� ttor -0 G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> OWNER l Ny L/ j I C/� ,/ TELEPHO ��Ap1�/ `,g (.� <br /> HOME ADDRESS � /�� 1�-�,L� f 6� �� �f� 'IVr��/r�LLF �U" O <br /> r � � <br /> t/ 0 <br /> EMERGENCY/FIRE NUMBER �JX ROAD NAME <br /> t� 7C �F' c <br /> LEGAL DESCRIPTION(see tax receipt) ) —Y� F A) 1-T S°tr�ZlYt��� T/v /ri�,���Gi7 1 0 <br /> o <br /> f/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION Cx� Q <br /> n <br /> rn <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> � Q <br /> STRUCTURE/ADDITION USE: I��1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 1 ' <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x N <br /> RIAL OR TOP VIEW) O o <br /> T o 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). C o <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 LAKE, aZ <br /> 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 BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N rA�J' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS i 0 �1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I ) <br /> 0 `3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z ' <br /> CONDITIONS OF PERMIT: P Q <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. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS,jt4VER Ur1LESS SP �IFICA5. LLrRMI <br /> ;a -U C)rmODO � <br /> 6. 3 am xQfD .'C <br /> 7. / <br /> V ° <br /> lU) : m <br /> I declare that this application (including any accompanying schedule) has e n examined y e o th st of my (j c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I amB or the detail an uracy of <br /> all information contained in this application(including any accompanying schedu en� t cognize Cm i M <br /> that this information I am providing will be relied upon by the County of Burnett Wise ii pq njwhether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett—rely n 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. m <br /> - : <br /> m <br /> SIGN HERE m <br /> ignature of owner or builds ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N N fT N <br /> N UtOUt L" C) <br /> TOWNSHIP PERMIT0 0 0 0 0 0 S MA BE REQUIRED b o 0 0 <br /> 0 <br /> 1�� <br />