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Burngtt Coprity 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> -�-- TELEPHONE c <br /> OWNER IAMF�M <br /> `7/S- 8b � -'7/75 � <br /> HOME ADDRESS 90';PFC7- ST OAAlRW v Uh 511830 V <br /> J <br /> EMERGENCY/FIRE NUMBER �` ,p ROAD NAME /P,P Si;'FGT % <br /> LEGAL DESCRIPTION(see tax receipt) TUI' �/O Rlro /07- /& 8A'K am <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE W ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: �i41QA/F o' <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: SE4F CA11P rA/rA-- _ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n r. <br /> f DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) T n <br /> 4fn Z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 0I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 1� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z u <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 V+ U, <br /> BUILDINGS,ROADS, LAKE,LOT LINES. b b <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 /> 5. <br /> m m <br /> L <br /> 6. 3 cy Hca A <br /> 'O y y <br /> a : y C y <br /> 7. C N CD �t <br /> co ,11 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w ECL <br /> C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize '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 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. <br /> -n : <br /> ' <br /> m : <br /> m : <br /> SIGN HERE 99 ' <br /> (signature of ow or building contractor) (date) <br /> ZONING ADMINISTRATOR �-' 'm FI An 1 <br /> kom <br /> NN N NCif N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />