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.:ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> c, <br /> rn 0 0 <br /> t W1 I. , IAS, ) � z `I M <br /> OWNER ►G�4 4 KJ r„�I�' TELEPHONE C�S o�— CtJ.� U l I 1 0 <br /> O <br /> HOMEADDRESS 3 Y� T�-ICO-S 4l.-e' 61A IMti S_7 Y+Z10 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 36 VT9 Si ass ROAD NAME <br /> �CTL e <br /> LEGAL DESCRIPTION (see tax receipt) T �� —'TI /!3- Cn <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): a . <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 0 <br /> STRUCTURE/ADDITION USE:�0 a (2/p 4rcrA � <br /> ro �') <br /> (Home/Cabi ; Commercial Business; Bedroom; Deck;etc.) Cn <br /> I N2. <br /> BUILDING CONTRACTOR: PHP, (/TDC RL�r Ir cpe4'C <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <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 o <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. C)N <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,I Cf TOR, ETC.,THE PLANS j, (1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. L���UU x( 77}n �;�( f/ 0 <br /> J plr f41�j(f D�1)(E "I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V IFICATI v � � <br /> NEEDED. nD <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 4r•, � .5 9 04 ; o / <br /> CONDITIONS OF PERMIT: ��f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS F PER <br /> R G CINry <br /> ISSUANCE. °�NIN <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 /> S TBACCK AREA. <br /> 5. -� DODO <br /> 'VCDSm <br /> This structure to be used as private residential <br /> X <br /> 6. 0 3 0 2 �Q m <br /> garage/storage only. Not to be used for human a c y o 3 <br /> habitation. Z " ° <br /> �. o -n ` m <br /> _ Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( C) - A <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C) <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 ° <br /> providing in this application. I agree to permit county o ' ' I .chatged with administering county ordinances or other <br /> authorized person to have ess to the above descri i at any reasonable time for the purpose of inspection. T <br /> m <br /> CD : <br /> SIGN HERE <br /> (signature of owner r building co rector) (date) <br /> ZONING ADMINISTRATOR . ' ' ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> 9a PhW Q as-o y <br />