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tsurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdministratorG <br /> APPLICATION FOR LAND USE PERMITS o <br /> r <br /> o <br /> OWNER TA? B Al A S J �� f fiL TELEPHONE 7/s J P a <br /> C3y� v <br /> HOME ADDRESS fC,17 �o <br /> /yo .A `W , M�e w,v 7 JrVn <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME o <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) L <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY S RUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): �, to 0 <br /> c � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Com roal Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) A N <br /> O m <br /> 'n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. gsu <br /> c� o 0 (?I` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. SAI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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 <br /> SETBACK AREA. <br /> 5. <br /> 6. n <3 n O d f <br /> T.`G O. W . N <br /> � � ��� � 100 (D 0 S-. � <br /> 7. 4 J <br /> Z <br /> O : 21 <br /> I declare that this application (including an accompanyingschedule has been examined ��tt�,.�Ss '` — �' m <br /> PP , 9 Y ) ��fftlraEdLt Y t7 ` C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible f racy of C <br /> all information contained in this application(including an accompanyingschedule and I further that I recognize ` m <br /> PP (� 9 Y ) � t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 a, <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> m <br /> SIGN HERE '. <br /> 7- 1 <br /> (signature of o er r bu)Kding contrac / / (date) <br /> ZONING ADMINISTRATOR c/ <br /> TOWN HIP PERMITS MAY BE REQUIRED <br /> — V <br />