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Pur.left C6tjnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> OWNER rJiCyfQtL/�I tC IICH>�GZSK/ TELEPHONE <br /> m ^ <br /> HOME ADDRESS /,V-7 a T4 4," ,6 JFZ,7ej 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4sPetXj 4e� pp �� ,, <br /> LEGAL DESCRIPTION(see tax receipt) a 360 — �7,P w <br /> 0 <br /> DWELLING/BUILDING �ARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY EJ <br /> TYPE OF PERMIT(S): c ' Yl <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> W. <br /> STRUCTURE/ADDITION USE: c <br /> ome/Cabin; ommercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: DGD Q ^ s.� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> Mn Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). CO) c <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 WATER MARK(OHWM)OF l4 <br /> ' LAKE,STREAM OR RIVER AND MEASUREMEN1.12MTLAZ <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. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( o� <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. is to o <br /> LP" <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> (� O <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. M v� nn <br /> ? O nD A v <br /> 109 Q. <br /> m c m . c � 3 <br /> 7. Z ' <br /> o <br /> =N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j , : ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizeCDm <br /> M <br /> that this information I 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 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. -n <br /> m <br /> m <br /> SIGN HERE <br /> 925 l� <br /> (siinatureofowneroldmifcontror) (date) \ <br /> ZONING ADMINISTRATOR G� • • • . fn <br /> N NNNNfT V1 <br /> V1 VI O Vl V1 O O <br /> TOWNSHIP ERMITS MAY BE REQUIRED o c c o 0 0 0 <br /> 0000000 <br />