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Rurn,stWCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator m w <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> N � <br /> OWNER o( :�)CaS J 01SOry TELEPHONE ')1�ay�.ygY� n• <br /> o f <br /> HOME ADDRESSq KS 5+�, 'p-W L ,__ _ I ( ,LS 5�(D, =° <br /> LC..r`►vlCu� W � <br /> °r m <br /> EMERGENCY/FIRE NUMBER a g q 85 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) S W y <br /> 70/U y <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY RUCTURE TYPE OF PERMIT(S): ADDITION ❑ PRIVY C/ oy <br /> 0 <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION q <br /> m <br /> STRUCTURE/ADDITION USE: 1 <br /> me/Cabin; Commercialbusiness; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> v r-- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 Q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 17-n <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) CD <br /> n m <br /> -n d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <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 <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 /> S. 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. c <br /> � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN oa g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ^1 J <br /> CONDITIONS OF PERMIT: ° 1 v I <br /> rl� Ir <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. jj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C�' <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � -00r- D 00 .0 <br /> 6. n W d ID m <br /> m cmwc A <br /> m C w C <br /> 7. Z '" m,°�� f° 1 <br /> o <br /> Cn <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my �j -r <br /> ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : c <br /> m � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized personhave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> ign re owner or b ' in ontrac or) (date) <br /> ZONING ADMINISTRATOR . <br /> t» f»f»to cA w En <br /> N N N VtNN V1 O (T P 00(T <br /> U1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />