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Burriett 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 /> OWNER <br /> lb �Sn La TELEPHONE S�� <br /> HOME ADDRESS y3 ���j�y O <br /> CD <br /> CD <br /> �') k <br /> EMERGENCY/FIRE NUMBER ROAD NAMEAZ 7 l <br /> LEGAL DESCRIPTION (see tax receipt) 6—L p� / 7— V/ <br /> W m <br /> 0 <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ m 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ n <br /> m <br /> STRUCTURE/ADDITION USE: T/rt / [SLS/P� (O /C [O o o <br /> (Home/C n; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: A1110yi- <br /> c� <br /> v. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 9, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n (� <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m" <br /> n a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ZZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C? <br /> NORTH(N). <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 (� <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. <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 o 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o I0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN )E, <br /> NEEDED. 0 p ` <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. vV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r 0 0 -U <br /> 6. ion 3 CL a'X � <br /> m C N m c C <br /> ' o <br /> 7. o y <br /> —_ cn : <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m c m <br /> pp ( 9 Y ) Y Y Q G� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v( C <br /> n � .O <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- O <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 m <br /> authorized person to have access to theAbove descr' ed premises at any reasonable time for the purpose of inspection. <br /> CD : <br /> m <br /> SIGN HERE <br /> (signatur f owner or i c�tractor) (date) <br /> ZONING ADMINISTRATOR ""+ <br /> to v+to to to to <br /> N N (TNNN V7 <br /> Vt ut O (/ Ut O O <br /> TO PERMITS MAY BE REQUIRED o a <br />