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.County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y o <br /> T j o n <br /> OWNER SC©'� f �J GL/�L�Z� TELEPHONE�O -�pr} 7—733 a. O <br /> ` \ <br /> O <br /> HOME ADDRESS 9 3 <br /> f� -/ 0 m <br /> EMERGENCY/FIRE NUMBER /70 Q ROAD NAME S�Kes PZcL r <br /> gC <br /> LEGAL DESCRIPTION(see tax receipt) SHO Ole/4/t-�7 AC"� ` y <br /> DWELLING/BUILDING % GARAGE/ACCESSORY STRUCTURE 0 ADDITION ❑ PRIVY ❑ Q C <br /> TYPE OF PERMIT(S): OJ A <br /> FILLING/GGR�ADDIN fG ❑ CAMPING UNIT El SUBDIVISION ❑ < ' ') <br /> STRUCTURE/ADDITION USE: <br /> L_JGCJJ�t n f Q�S Pi �V 1` O I& IrOOF 1 1111 0 <br /> (Home/Cabin; Comm tial Business; Bedroom; Deck; etc.) Cn p <br /> L � <br /> BUILDING CONTRACTOR: lir <br /> Czv <br /> m <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. <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) �� -n o <br /> a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 C' 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 rj�.pJ <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. v 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Er ° <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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. L /1 <br /> s. �Lb�ONIy , /L'J 'fir Siar� Lo�+s c� �7lOw�l U vi '9 z v 0 r8n o o v <br /> J m <br /> N <�. d N N R <br /> 6. " � L N G 3 aW 7rR. x <br /> U) . m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of in Lj C <br /> knowledge and belief it is true,correct and complete. I 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 m 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 I am <br /> providing in this applicaon. I a ee permit county officials charged with administering county ordinances or other m <br /> authorized person to h cc o above describe remises at any reasonable time for the purpose of inspection. -n <br /> Q : <br /> m <br /> SIGN HERE <br /> gnatu of nerorbui g ntr r) (date) <br /> ZONING ADMINISTRATOR d, <br /> N N 01 N N <br /> P PON O <br /> O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />