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PX01(p <br /> Burnal-'County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 5T a <br /> / tij��---� N <br /> OWNER �- <br /> TELEPHONE 3a/a <br /> /I �— �7�� O \ rW <br /> HOME ADDRESS CCN— 36 v 0 <br /> (((111 n � r m <br /> EMERGENCY/FIRE NUMBER ROAD NAM <br /> ��7 r <br /> [�[ 1 <br /> LEGAL DESCRIPTION(see tax receipt) a `�— / Q �� rn <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y0 <br /> TYPE OF PERMIT(S): c 0 <br /> Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION CL <br /> Sh, P / S—lS b <br /> STRUCTURE/ADDITION USE: V /7 0 \ <br /> (Home/Cabin; C mmercial Business; Bedroom; eck; etc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In c <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n n <br /> rn 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 <br /> m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) \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. v <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. to <br /> c I <br /> 0. 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 0 <br /> NEEDED. g <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: n <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT pd <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m - on+ r. � 00 -a <br /> 6. a ' CL 0 1W <br /> m Cin <br /> 7. z @ <br /> o : 70 <br /> y : . <br /> Y <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m wE G) A <br /> — Cr m <br /> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm Er C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection <br /> T <br /> ID <br /> W <br /> SIGN HERE <br /> (signature of wner or building co trr ctor)) (date) C) <br /> ZONING ADMINISTRATOR <br /> N NP N NCn Ot <br /> Vt VtO Vt fT OO <br /> WNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />