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UI W ^P <br /> Office of Zoning Administrator (D 0 0 <br /> Jurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 <_ <br /> APPLICATION FOR LAND USE PERMITS N r- <br /> CD <br /> �j CL <br /> TELEPHONE �J437" /1` <br /> OWNER A V D� <br /> L�1 . gloow,�;v� � rau s� 3 Q <br /> HOME ADDRESS 0 <br /> 0 <br /> �, �4L ROAD NAME � jAlBZ <br /> EMERGENCY/FIRE NUMBER <br /> W cn <br /> ✓-i zo��13�3-°! -�3zo <br /> LEGAL DESCRIPTION(see tax receipt) (. Cs*l (-013 3 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c5 o <br /> L <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVI ION v; <br /> cn <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comm clal Business, Bedroom, Deck etc) m <br /> BUILDING CONTRACTOR: � <br /> I <br /> CD <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; m <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 3 <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)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AN <br /> BUILDINGS,ROADS,LAKE,LOT LINES. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I = <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. C o <br /> o `1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN V� \ <br /> NEEDED. Z J� <br /> 0 <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 /> UU <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I 1Xvl, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. F c5� �7 ,, /, m un 0- :E m <br /> 5. U i✓ �/ m < 30 C:m m <br /> S cY� `` 0 "`" � mNo <br /> ! <br /> 6. at <br /> aQ�Qr1�lXyw, o n m <br /> schedule) has been examined by me and to the best of my @ c !C <br /> I declare that this app ica ion (i I Yaccompanying f m m <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible rt a detail accuracy C o . O <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 i i determining whether tom d <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I he <br /> providing in this application. I agree to permit county officials charged with administering county ordinances a other <br /> CD <br /> authorized person to have ass to the ab escribed prem' es at any reasonable time for the of inspection. m <br /> SIGN HERE L <br /> (signature of owner or it con ctor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP P MITS MAY BE REQUIRED <br />