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Surnatt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 5 <br /> OWNER /� ����� TELEPHONE <br /> --;990W If 7A-3 n <br /> - 5"`77 -9�s« O <br /> HOME ADDRESS /7P.I/ Wc—)Ua` lowe- 41o• li,owor, k /Nil. 5—S�LSIf/ v <br /> // L/ o <br /> EMERGENCY/FIRE NUMBER 3 9� 3 ROAD NAME <<7/fC yr. <br /> ,40t A#'l sC- //y 0P sur i,/ yodrr)nenf /or -s' <br /> LEGAL DESCRIPTION(see tax receipt) 5& . 7 T yt N R/5'k) S it)j S:i r9P, i 0 <br /> rqo <br /> e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE1:1 ADDITION PRIVY ❑ U) 0 <br /> TYPE OF PERMIT(S): <br /> d � <br /> FILLING/GRADING ❑ CAMPI G/U�NIT ElSUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: �(7QRF}�F nl=(' _ 1 1 I <br /> (Ho a/Cabin; Comme tial Business; Bedroom; Deck;etc.) vi <br /> m <br /> BUILDING CONTRACTOR: St7 ill e; fv <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 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). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. U` o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 0, <br /> c <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 REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;aM 0r'- 0�0 'O <br /> 0W cfD I m <br /> N C N N J i <br /> 7 <br /> 7. Z . <br /> o : m ' <br /> = cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m <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 1 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 J 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 the above described premises at any reasonable time for the purpose of inspection. m ; <br /> CD : <br /> pp m : <br /> SIGN HERE <br /> (signature of caner building contractor) (date) o <br /> ZONING ADMINISTRATOR I <br /> N N (TNNVt <br /> Vt VtO(TN O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 0 0 0 <br /> 0 <br /> 0 000 0 <br />