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f IrnEn.^ounty 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> H o <br /> m <br /> OWNER ( GV�' C- ��/13p ,DE�� INl n-TLEPHONE SOC?-�/L3' o <br /> HOMEADDRESS <br /> r M � <br /> EMERGENCY/FIRE NUMBER �Y� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) a9 _ �D —/!'7 7 Q <br /> / 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE r. <br /> ADDITION ❑ PRIVY ❑ y C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNITFP SUBDIVISION ❑ S. <br /> LA <br /> STRUCTURE/ADDITION USE: STBZ AC�� 11 PtZ1�{Ac � 36x `; <br /> 11 (Home/Cabin;�L'ommercial Busin ss; Bedroom; Deck;etc.) <br /> 11 <br /> BUILDING CONTRACTOR: �" 01,Aj=0Sb)Q -T1- (rte <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> � N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n cL <br /> N Z <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 C n <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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 O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ° <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o "r'� <br /> CONDITIONS OF PERMIT: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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 /> SETB CK AREA. <br /> 5. b� rS — C� �2 Cs�� jh 7`T� JQ/lie . <br /> ?y : 0CU0o' � X <br /> 7. o i �'< : <br /> _m i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i i m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 applic I gr to permit county officials charged with administering county ordinances or other m <br /> authorized person to a he ove described premises at any reasonable time for the purpose of inspection. m <br /> M :: <br /> y m : <br /> SIGN HERE <br /> (signature of ner or building CO tor) (date) <br /> ZONING ADMINISTRATOR <br /> N NUINN (n V1 <br /> Vt frON (1i00 <br /> (,TWNSHIP PERMITS MAY E REQUIRED 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />