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Burni,t Cot)nty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F ° <br /> OWNER ��; Q 6 t�0 TELEPHONE <br /> � c? <br /> HOME ADDRESS t6 &p 531 aJJdn (l(5 syg.sa 9 <br /> EMERGENCY/FIRE NUMBER a Qa ROAD NAME a/. N <br /> rcn ii o`7 _o26 - - - ya- /6 <br /> LEGAL DESCRIPTION (see tax receipt) Q { ti <br /> �ver� oaks �lfl L <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ �`' CO o <br /> TYPE OF PERMIT(S): �Q <br /> FILLING/G(RIADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: C31 r4!!)0 PAr�k�w ; i�I`ny� <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0i Att E <br /> BUILDING CONTRACTOR: �r`w/i G SCA A/Js tv <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;aN c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) o <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. P <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. ly ` <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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° <br /> NEEDED. \) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT. " III <br /> ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 9/ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 /> 5. <br /> ;avW = M In <br /> m m e m a m <br /> 6. o m cm, 0 o 3 <br /> ly : In <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m <br /> // n, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize " 1 m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ppp� y O <br /> sue a permit. 1 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 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signature of o ner or building co c�r)l (date) <br /> ZONING ADMINISTRATOR � 2� <br /> ' NEn NN VUi C" <br /> PO <br /> P n X 0 0 <br /> TO NSHIP PERMITS MAY B REQUIRED r o C> <br /> 0 0 0 0 0 <br /> 0 CD CD <br />