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BL to County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 <br /> C �J <br /> N <br /> OWNER TELEPHONE 3— U o <br /> m <br /> it 0 <br /> HOME ADDRESS <br /> T <br /> EMERGENCY*IRE NUMBER bC Igna ROAD NAM r . , <br /> C' tic y W <br /> LEGAL DESCRIPTION(see tax receipt) XJ CD <br /> y <br /> �. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADD ION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> L34 <br /> FILLING/GRADING ❑ CAMPING UNIT [Ell SUBDIVISION S. <br /> T <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: �(hm <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _ <br /> A � <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> ?+ C Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). to <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 /> 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 /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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. o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: O <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> i <br /> 5. IPS 3 aio Si'c m <br /> 6. 'O : N C y y O 3 <br /> :j,'<7. -rn t t <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bestof my 7 Ca c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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 "per her accept all liability which may be a result of the County of Burnett relying on this information I am m E <br /> prove ing in this a plication. I agree to permit county officials charged with administering county ordinances or other m <br /> authon d person h ve access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> S to <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR d+b"r^Fa 40 w <br /> N NOT N Nuhn <br /> N MOMEMOO <br /> A 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED IVT <br />