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2 Siren WI 54872 Office of Zoning Administrates o �o <br /> qty 7410 Co. Rd. K, No. 10 , 3 <br /> APPLICATION FOR LAND USE PERMITS NI. <br /> 7 .4 TELEPHONE 0 <br /> OWNERCD <br /> HOME ADDRESS 0 <br /> 0 <br /> 1 <br /> C <br /> EMERGENCY/FIRE NUMBER ROAD NAME }✓ <br /> laza.- <br /> P) Y � � <br /> LEGAL DESCRIPTION(see tax recei t o <br /> y o <br /> � c � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCT RE ADDITION ❑ PRIVY 0- <br /> TYPE <br /> TYPE OF PERMIT(S): ON <br /> !� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISI <br /> 1// oY a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Coµtmercial Business, Bedr m,Deck,etc) m <br /> f � � <br /> a �/1 <br /> BUILDING CONTRACTOR: U V <br /> v <br /> ID <br /> T 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR p _ O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; N <br /> c <br /> O o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n . <br /> o z <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 30 <br /> m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE a B <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O <br /> ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND <br /> BUILDINGS,ROADS,LAKE,LOT LINES. r` Ski <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ <br /> 5. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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 /> P0 � mar0MCL� m <br /> 5. n 3 a m 9— Z1 <br /> OLD.'< -a N N <br /> -° ` w O m -� <br /> 6. o T m <br /> 7. <br /> Cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c , m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I 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 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> ding <br /> a is info. 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 application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE (date) <br /> (signature of owner or bu' � g contractor)1~J ! 'v`J <br /> � Q <br /> ZONING ADMINISTRATOR (� <br /> TOWNSHIP PERMITS MAY BE REQUIRED !V� <br />