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on <br /> Bur"tt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> N <br /> l � <br /> OWNER m/I/1moi (/ LEPHONE <br /> f H <br /> HOME ADDRESSAfe <br /> �- J <br /> LC/ o E <br /> EMERGENCY/FIRE NUMBER � G � ROAD NAME�r�/���`jLp� ' <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt)4 )-17 C6M V n �� (�D�/� <br /> V c' / rn <br /> 0 <br /> DWELLING/BUILDING. GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ V) o <br /> TYPE OF PERMIT(S): O <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> arm X 4� - GC�y-arc <: xag S.y <br /> STRUCTURE/ADDITION USE: /- O�'l <br /> gnome/Cabin, Commercial Business; Bedroom; Ded(,etc.) y L <br /> BUILDING CONTRACTOR: �(�})1 �/ Sl`f'j2 E <br /> iii �n <br /> � 1 <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. CYLti/� y g yy O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 4 T r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Oz <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ?T <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 j <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ^) c <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. r c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <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 p <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1 <br /> 6. a 3= CD e m <br /> D cH �o� 3 <br /> 7. z Ngo : <br /> o ? i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my :` ': p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize C m 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 <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 ab described premises at any reasonable time for the purpose of inspection. <br /> m <br /> M :: <br /> SIGN HERE �, l 3_ <br /> (si atu of o e u Ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> w w to w <br /> N N V1 N N ul <br /> V7 (! O V7 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o <br />